Physicians often find it hard to tell if a patient suffering from dementia or depression is capable of making sound judgements. This is shown by a study conducted within the scope of the National Research Programme “End of Life” (NRP 67). The Central Ethics Committee of the Swiss Academy of Medical Sciences now aims to elaborate new assessment principles.
The question whether a patient is capable of making sound judgements is of central importance for all medical treatments. Only patients who are able to understand, retain and weigh the information they receive from the physician can give their valid consent to a treatment. If the patient’s decision-making capacity is impaired, according to current legislation the physician needs to consider a living will or consult a patient-appointed proxy.
“Brain injuries or illnesses such as dementia or severe depression can cause an incapacity to make decisions,“ says Manuel Trachsel, senior assistant at the Institute for Biomedical Ethics of the University of Zurich. This is particularly so when people with a terminal illness reach the end of life. Some crucial and complex decisions are needed at this stage: Should life-prolonging measures be discontinued? Is the patient perhaps contemplating an assisted suicide?
Anything but trivial
“Assessing someone’s decision-making capacity is anything but trivial,“ says Trachsel. The result of the assessment may not be the same for all situations. For instance, someone may be regarded as capable of adequate decision-making when it comes to everyday matters such as clothes or food, but as incapable of just this in relation to a difficult medical decision. In addition, the cognitive capacities of patients suffering from Alzheimer’s or Parkinson’s disease can fluctuate considerably from day to day. In a specialist journal, Trachsel and his colleagues Helena Hermann and Nikola Biller-Andorno recently discussed how physicians might nonetheless be able to assess decision-making capacity in such difficult circumstances (*).
But what do physicians understand by “decision-making capacity” in the first place? In the context of the National Research Programme “End of Life“ (NRP 67), Trachsel interviewed around 760 physicians from all over Switzerland. The results, which have now been published (**), suggest that the vast majority of physicians feel they are responsible for assessing the patient’s decision-making capacity. However, even among those with a very strong sense of responsibility, only about one third believe they are competent enough.
Rules of thumb vs guidelines
Physicians show a lack of consensus when it comes to defining decision-making capacity, identifying the key assessment criteria and describing the way in which they assess someone’s ability to make decisions. “Most physicians apply their own rules of thumb to determine whether a patient is capable of making decisions or not,” says Trachsel. Few of them are aware that various guidelines for assessing someone’s decision-making capacity are already in place.
Nevertheless, among the interviewed physicians an overwhelming majority expressed a desire to have access to such assessment tools. A large majority was in favour of clear guidelines and showed an interest in taking courses on the subject. These innovations will soon be a reality: based on the results of the survey, the Central Ethics Committee of the Swiss Academy of Medical Sciences (SAMS) has decided to engage with the topic and elaborate principles for assessing medical decision-making capacity as of next year.
(*) Manuel Trachsel, Helena Hermann, Nikola Biller-Andorno (2014). Cognitive Fluctuations as a Challenge for the Assessment of Decision-Making Capacity in Patients with Dementia. American Journal of Alzheimer’s Disease online. doi: 10.1177/1533317514539377
(available to journalists as a PDF file from firstname.lastname@example.org)
(**) Helena Hermann, Manuel Trachsel, Christine Mitchell, Nikola Biller-Andorno (2014). Medical decision-making capacity: knowledge, attitudes, and assessment practices of physicians in Switzerland. Swiss Medical Weekly online. doi: 10.4414/smw.2014.14039
Dr Manuel Trachsel
Institute for Biomedical Ethics and History of Medicine
University of Zurich
Tel.: +41 78 685 44 54
Media - Abteilung Kommunikation | idw - Informationsdienst Wissenschaft
Innovative genetic tests for children with developmental disorders and epilepsy
11.07.2018 | Christian-Albrechts-Universität zu Kiel
Oxygen loss in the coastal Baltic Sea is “unprecedentedly severe”
05.07.2018 | European Geosciences Union
For the first time ever, scientists have determined the cosmic origin of highest-energy neutrinos. A research group led by IceCube scientist Elisa Resconi, spokesperson of the Collaborative Research Center SFB1258 at the Technical University of Munich (TUM), provides an important piece of evidence that the particles detected by the IceCube neutrino telescope at the South Pole originate from a galaxy four billion light-years away from Earth.
To rule out other origins with certainty, the team led by neutrino physicist Elisa Resconi from the Technical University of Munich and multi-wavelength...
For the first time a team of researchers have discovered two different phases of magnetic skyrmions in a single material. Physicists of the Technical Universities of Munich and Dresden and the University of Cologne can now better study and understand the properties of these magnetic structures, which are important for both basic research and applications.
Whirlpools are an everyday experience in a bath tub: When the water is drained a circular vortex is formed. Typically, such whirls are rather stable. Similar...
Physicists working with Roland Wester at the University of Innsbruck have investigated if and how chemical reactions can be influenced by targeted vibrational excitation of the reactants. They were able to demonstrate that excitation with a laser beam does not affect the efficiency of a chemical exchange reaction and that the excited molecular group acts only as a spectator in the reaction.
A frequently used reaction in organic chemistry is nucleophilic substitution. It plays, for example, an important role in in the synthesis of new chemical...
Optical spectroscopy allows investigating the energy structure and dynamic properties of complex quantum systems. Researchers from the University of Würzburg present two new approaches of coherent two-dimensional spectroscopy.
"Put an excitation into the system and observe how it evolves." According to physicist Professor Tobias Brixner, this is the credo of optical spectroscopy....
Ultra-short, high-intensity X-ray flashes open the door to the foundations of chemical reactions. Free-electron lasers generate these kinds of pulses, but there is a catch: the pulses vary in duration and energy. An international research team has now presented a solution: Using a ring of 16 detectors and a circularly polarized laser beam, they can determine both factors with attosecond accuracy.
Free-electron lasers (FELs) generate extremely short and intense X-ray flashes. Researchers can use these flashes to resolve structures with diameters on the...
13.07.2018 | Event News
12.07.2018 | Event News
03.07.2018 | Event News
19.07.2018 | Materials Sciences
19.07.2018 | Earth Sciences
19.07.2018 | Life Sciences