Do clinicians follow a risk-sensitive model of capacity-determination? An experimental video survey

The authors asked whether clinicians use a risk-sensitive model for decisional-capacity determinations; that is, whether a higher degree of capacity was required in higher-risk situations. The respondents were randomly assigned to view a videotaped "capacity" interview of a medication-randomized clinical trial scenario (N=52) or a neurosurgical clinical trial scenario (N=47). A significant scenario effect was mediated by the respondents' perception of scenario-specific risk. Respondents showed considerable disagreement within each scenario that was not explained by clinician-specific factors. Thus, clinicians, in fact, use the normative risk-sensitive model for capacity, but there remains considerable unexplained variability in their judgments.