Acceptance and insight: incapacity to give informed consent

To highlight areas for potential refinement in assessments of capacity to give informed consent.

The clinical assessment of the patient's capacity to give informed consent may be informed and guided by sophisticated criteria or assessment instruments. The approach of most assessment instruments and the literature on (in)capacity departs from the abilities that underpin giving informed consent. This approach may be refined, however, by assessing clinically for a causal connection between the mental disorder in the mind of a particular person and the particular inability. It may furthermore be refined by assessing that aspect of insight that is best connected to incapacity, for insight has been found to be the best clinical discriminator of capacity status in patients with psychotic and manic disorders.

To find that a person is incapable by virtue of a mental disorder, a causal connection between the mental disorder and the particular inability should be assessed clinically for the very patient. Furthermore, the term 'acceptance' is more apt than 'appreciation' and 'belief' in capturing that aspect of insight by which a person with psychotic and manic disorders may be rendered incapable of giving informed consent.