Determination of decisional capacity in patients exhibiting psychiatric symptoms

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I currently work as a psychiatric liaison for a large general hospital. I am responsible for conducting psych-social evaluations on patients who, while on the medical floors, exhibit psychiatric symptoms. I am also an active member of the hospital’s Bioethics Committee. As part of my job, I receive requests for evaluations to determine a patient’s decisional capacity. During the past few months I have seen an increase in requests to determine a patients capacity to provide informed consent for medical procedures. I decided to discuss this issue because it has great ethical and legal implications for all involved. In the hospital, primary physicians order evaluations to determine whether their patient has lost capacity to make their own decisions. The implications of the results of these evaluations are very serious, often controversial and could mean that a patient may end up having a procedure they did not want. These evaluations often raise ethical questions regarding a patient’s right to choose. These evaluations can also lead to disagreements and discord among the healthcare professionals involved in the care of the patient. I have noticed that physicians and other medical professionals are often quick to judge patients as lacking capacity to make decisions. Physicians sometimes assume that psychiatric symptoms equate with limited decisional capacity. I have found, while interviewing patients, that they may lack a basic understanding of the risks, benefits and alternatives of a procedure even after their doctor has explained the procedure to them. I also find that patients are often afraid to ask their doctor questions or seek clarification. In closing, I feel that the issue of decisional capacity could provide a great opportunity for healthcare professionals with expertise in this field to educate staff and patients and to offer clarification when questions arise regarding a patient’s decisional capacity.

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