Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals / Edition 1

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Overview

One of the most challenging tasks facing clinicians today is the assessment of patients' capacities to consent to treatment. The protection of a patient's right to decide, as well as the protection of incompetent patients from the potential harm of their decisions, rests largely on clinicians' abilities to judge patients' capacities to decide what treatment they will receive. However, confusing laws and the complicated ethical issues surrounding the concept of competence to consent have made the process of competence assessment intimidating for many clinicians. Health professionals—physicians, medical students, residents, nurses, and mental health practitioners—have long needed a concise guidebook that translates the issues for practice. That is what this book accomplishes.
This volume is the product of an eight-year study of patients' capacities to make treatment decisions—the most comprehensive research of its kind. The authors describe the place of competence in the doctrine of informed consent, analyze the elements of decision-making, and show how assessments of competence to consent to treatment can be conducted within varied general medical and psychiatric treatment settings. The book explains how assessments should be conducted and offers detailed, practice-tested interview guidelines to assist medical practitioners in this task. Numerous case studies illustrate real-life applications of the concepts and methods discussed. Grisso and Appelbaum also explore the often difficult process of making judgments about competence and describe what to do when patients' capacities are limited.
A timely, practical handbook relevant to every medical specialty, Assessing Competence to Consent to Treatment will benefit a wide array of medical practitioners—including physicians, medical students, residents, nurses, and other allied health professionals—who need to assess the mental competence of patients in their everyday practice. It will also interest ethicists and moral philosophers, as well as geriatricians and clinical psychologists working with cognitively impaired patients.

The book contains black-and-white illustrations.

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Editorial Reviews

Doody's Review Service
Reviewer: Douglas E. Tucker, MD (Rush University Medical Center)
Description: This is a practical, clinician-oriented guide to the assessment of competence to consent to treatment.
Purpose: Its purpose is to provide some clarity and guidelines for caregivers in a complex and confusing area, in which the stakes can be enormous (often life-and-death) but the standards to be applied are often too abstract and inconsistent to be of much help. This book thus serves an important clinical need, and it meets its objective admirably.
Audience: As stated in the title, this book was written for the broad group of physicians and other health professionals, but it will be particularly valuable for those working "in the trenches" in critical care, and geriatric and mental health settings. Both authors are well known and respected authorities in forensic mental health, and have written extensively on the capacity to make treatment decisions.
Features: The book is relatively small and short, and is not illustrated except for a half-dozen tables and a data collection form. It has only 37 references, but this is a deliberately succinct and carefully chosen list of pertinent, clinically useful sources. The appendix contains the format, procedure, and data recording form for the MacCAT-T (MacArthur Competence Assessment Tool-Treatment), a semistructured interview instrument developed by the authors and designed to systematically elicit and organize information about decision-making abilities.
Assessment: This is a very practical and useful book for any clinician who provides treatment to patients for whom competence to consent is an issue. It is quite user-friendly, with convenient chapter summaries and many illustrative clinical vignettes. It will be more helpful to the busy practitioner facing real life treatment dilemmas than to the ivory tower academic. It should be made available in medical school and hospital libraries, although many individuals will wish to purchase it (particularly if a less expensive softcover version is produced).
New England Journal of Medicine
The authors stress that...difficult judgments about decision-making capacity should be made by the patient's attending physicians; routine psychiatric consultation or involvement of the courts is neither feasible nor desirable. These decisions require expertise, judgment, and wisdom. This book provides extremely useful guidance.
Douglas E. Tucker
This is a practical, clinician-oriented guide to the assessment of competence to consent to treatment. Its purpose is to provide some clarity and guidelines for caregivers in a complex and confusing area, in which the stakes can be enormous (often life-and-death) but the standards to be applied are often too abstract and inconsistent to be of much help. This book thus serves an important clinical need, and it meets its objective admirably. As stated in the title, this book was written for the broad group of physicians and other health professionals, but it will be particularly valuable for those working ""in the trenches"" in critical care, and geriatric and mental health settings. Both authors are well known and respected authorities in forensic mental health, and have written extensively on the capacity to make treatment decisions. The book is relatively small and short, and is not illustrated except for a half-dozen tables and a data collection form. It has only 37 references, but this is a deliberately succinct and carefully chosen list of pertinent, clinically useful sources. The appendix contains the format, procedure, and data recording form for the MacCAT-T (MacArthur Competence Assessment Tool-Treatment), a semistructured interview instrument developed by the authors and designed to systematically elicit and organize information about decision-making abilities. This is a very practical and useful book for any clinician who provides treatment to patients for whom competence to consent is an issue. It is quite user-friendly, with convenient chapter summaries and many illustrative clinical vignettes. It will be more helpful to the busy practitioner facing real life treatmentdilemmas than to the ivory tower academic. It should be made available in medical school and hospital libraries, although many individuals will wish to purchase it (particularly if a less expensive softcover version is produced).

4 Stars! from Doody
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Product Details

  • ISBN-13: 9780195103724
  • Publisher: Oxford University Press, USA
  • Publication date: 2/28/1998
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 224
  • Product dimensions: 8.30 (w) x 5.40 (h) x 1.00 (d)

Meet the Author

Thomas Grisso, Ph.D. is Professor of Psychiatry and Director of Forensic Training and Research at the University of Massachusetts Medical Center.
Paul S. Appelbaum, M.D., is the A.F. Zeleznik Professor of Psychiatry, and Chairman of the Department of Psychiatry at the University of Massachusetts Medical Center. His books include: Trauma and Memory: Clinical and Legal Controversies (OUP, 1997) and Almost a Revolution: Mental Health Law and the Limits of Change (OUP, 1994).

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Table of Contents

1 Why Competence Is Important: The Doctrine of Informed Consent 1
2 Thinking About Competence 17
3 Abilities Related to Competence 31
4 When Patients' Decision Making Should Be Assessed 61
5 Assessing Patients' Capacities to Consent to Treatment 77
6 Using the MacArthur Competence Assessment Tool - Treatment 101
7 Making Judgments About Patients' Competence 127
8 Substitute Decision Making for Incompetent Patients 149
References 169
App Manual for the MacArthur Competence Assessment Tool - Treatment (MacCAT-T) 173
Index 201
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