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Consent in impaired populations.

Paul S Appelbaum¹

¹New York State Psychiatric Institute, Unit #122, 1051 Riverside Drive, New York, NY 10032, USA. psa21@columbia.edu

Current Neurology and Neuroscience Reports

|June 16, 2010

Summary

Patients with cognitive impairments, including dementia, may have reduced capacity for informed consent. Structured evaluations and legal options like advance directives can help ensure patient rights are respected.

Area of Science:

Neuroscience
Medical Ethics
Cognitive Psychology

Background:

Cognitive impairments, such as those seen in dementia, can affect a patient's ability to provide informed consent for medical treatment or research participation.
Mild cognitive impairment and early-stage dementia often lead to decrements in decisional abilities.

Purpose of the Study:

To review the impact of cognitive impairments on decisional capacity.
To discuss methods for evaluating and supporting patient consent.
To outline legal frameworks for substitute consent when capacity is lacking.

Main Methods:

Literature review on cognitive impairment and decisional capacity.
Discussion of clinical evaluation tools for competence.
Analysis of legal provisions for substitute consent.

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Main Results:

Most patients with mild dementia likely retain competence for consent, and some with moderate dementia may in specific situations.
Structured clinical evaluations and instruments can reliably assess decisional competence.
Legal options such as advance directives and familial consent serve as substitute consent mechanisms.

Conclusions:

Cognitive impairments necessitate careful evaluation of decisional capacity.
Evaluations should be designed to maximize patient performance to uphold autonomy.
When substitute consent is required, legal frameworks provide established options.