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Pyer M, Ward A. Developing a dementia friendly approach to consent in dementia research. Aging Ment Health 2024; 28:294-301. [PMID: 37885301 DOI: 10.1080/13607863.2023.2264216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES This paper explores the process of gaining consent from the perspectives of people living with dementia, their relatives/carers, and service providers. This is developed based on new primary qualitative research and addresses a gap in critical reflection on the practice and ethical process of research consent. METHODS A qualitative approach was used to conduct this research through the implementation of four focus groups run with people living with dementia (n = 12), two focus groups with family members (n = 6), two focus groups with service staff (n = 5). RESULTS Data was analysed thematically, to identify two core themes: consent as a journey and the flexible consent approach. These identified concerns with autonomy, decision making and placing people living with dementia at the centre of the consent process. The journey of consent emerged as central to supporting participation and enhancing the consent process. CONCLUSION The paper presents new evidence about the lived experience of research consent in the field of dementia, presenting the process of collecting consent in research as a flexible process that is best supported through a growing knowledge of participants and participation sites.
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Affiliation(s)
- Michelle Pyer
- Faculty of Health, Education and Society, University Drive, University of Northampton, Northampton, UK
| | - Alison Ward
- Faculty of Health, Education and Society, University Drive, University of Northampton, Northampton, UK
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Florack J, Abele C, Baisch S, Forstmeier S, Garmann D, Grond M, Hornke I, Karakaya T, Karneboge J, Knopf B, Lindl G, Müller T, Oswald F, Pfeiffer N, Prvulovic D, Poth A, Reif A, Schmidtmann I, Theile-Schürholz A, Ullrich H, Haberstroh J. Project DECIDE, part II: decision-making places for people with dementia in Alzheimer's disease: supporting advance decision-making by improving person-environment fit. BMC Med Ethics 2023; 24:26. [PMID: 37118723 PMCID: PMC10148477 DOI: 10.1186/s12910-023-00905-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/29/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The UN Convention on the Rights of Persons with Disabilities, and the reformed guardianship law in Germany, require that persons with a disability, including people with dementia in Alzheimer's disease (PwAD), are supported in making self-determined decisions. This support is achieved through communication. While content-related communication is a deficit of PwAD, relational aspects of communication are a resource. Research in supported decision-making (SDM) has investigated the effectiveness of different content-related support strategies for PwAD but has only succeeded in improving understanding, which, although one criterion of capacity to consent, is not sufficient to ensure overall capacity to consent. The aim of the 'spatial intervention study' of the DECIDE project is to examine an innovative resource-oriented SDM approach that focuses on relational aspects. We hypothesise that talking to PwAD in their familiar home setting (as opposed to a clinical setting) will reduce the complexity of the decision-making process and enhance overall capacity to consent. METHODS People with a suspected or confirmed diagnosis of dementia in Alzheimer's disease will be recruited from two memory clinics (N = 80). We will use a randomised crossover design to investigate the intervention effect of the decision-making place on capacity to consent. Besides reasoning capacity, which is part of overall capacity to consent and will be the primary outcome, various secondary outcomes (e.g., other aspects of capacity to consent, subjective task complexity, decisional conflict) and suspected moderating or mediating variables (e.g., meaning of home, demographic characteristics) will be assessed. DISCUSSION The results of the study will be used to develop a new SDM strategy that is based on relational resources for PwAD. If a change in location achieves the anticipated improvement in capacity to consent, future research should focus on implementing this SDM strategy in a cost-effective manner in clinical practice. TRIAL REGISTRATION DRKS00030799 .
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Affiliation(s)
- Janina Florack
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany.
- Klinikum Siegen, Siegen, Germany.
| | - Christina Abele
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Stefanie Baisch
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
| | - Simon Forstmeier
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
| | - Daniel Garmann
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
- Klinikum Siegen, Siegen, Germany
| | | | | | - Tarik Karakaya
- University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Jonas Karneboge
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
| | | | - Gregor Lindl
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
- University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Tanja Müller
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
| | - Frank Oswald
- Goethe University Frankfurt, Frankfurt Am Main, Germany
| | - Nathalie Pfeiffer
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
- University Hospital Frankfurt, Frankfurt Am Main, Germany
| | | | - Aoife Poth
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
- University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Andreas Reif
- University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Irene Schmidtmann
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anna Theile-Schürholz
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
| | | | - Julia Haberstroh
- Faculty V: School of Life Sciences, Department of Psychology, Psychological Aging Research (PAR), University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
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Badenhoop L, Baisch S, Penger S, Haberstroh J. The Role of Different Aspects of Communication Behavior in the Assessment of Capacity to Consent. GEROPSYCH 2023. [DOI: 10.1024/1662-9647/a000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Abstract: Any medical treatment that interferes with physical integrity requires the informed consent of a patient capable of such consent. For people with dementia, the capacity to consent is questioned even in the early course of the disease. Particularly diagnostic instruments like the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) often deny people with dementia the capacity to consent because of high confounding of the results with patients’ verbal abilities. To date, it remains unclear whether not only verbal but also nonverbal communication is associated with assessments of capacity to consent. The current study investigates associations between patients’ verbal and nonverbal communication behaviors as assessed by the measure for Communication Behavior in People with Dementia in Ambulant Settings (CODEMamb) and capacity to consent as assessed by the MacCAT-T. We expected the strongest positive associations for verbal communication behaviors compared to nonverbal communication behaviors. Data of N = 43 patients with dementia ( n = 8 capable of consent) were collected at two different German psychiatric clinics. The results show small to moderate correlations between the overall scores of CODEMamb and MacCAT-T. As expected, correlations were strongest for the verbal CODEMamb subscale. The results support current findings on the dependency of the MacCAT-T on verbal communication. Based on the findings, the discussion addresses how people with dementia can be enabled to make self-determined medical treatment decisions.
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Affiliation(s)
- Luise Badenhoop
- Psychological Aging Research, Department of Psychology, Faculty V: School of Life Sciences, University of Siegen, Germany
| | - Stefanie Baisch
- Psychological Aging Research, Department of Psychology, Faculty V: School of Life Sciences, University of Siegen, Germany
| | - Susanne Penger
- Psychological Aging Research, Department of Psychology, Faculty V: School of Life Sciences, University of Siegen, Germany
| | - Julia Haberstroh
- Psychological Aging Research, Department of Psychology, Faculty V: School of Life Sciences, University of Siegen, Germany
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Poth A, Penger S, Knebel M, Müller T, Pantel J, Oswald F, Haberstroh J. Empowering patients with dementia to make legally effective decisions: a randomized controlled trial on enhancing capacity to consent to treatment. Aging Ment Health 2023; 27:292-300. [PMID: 34989288 DOI: 10.1080/13607863.2021.2024797] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objectives: As our society ages, the incidence of age-related diseases increases and with it the number of medical treatments that require informed consent. Capacity to consent is often categorically questioned in persons with dementia (PwD) without appropriate assessment, depriving them of their right to autonomous decision-making. Supportive structures for PwD that comply with legal requirements are lacking. The EmMa project tried to overcome this shortcoming by developing and testing possible supportive measures to enhance the informed consent process for PwD.Method: These enhanced consent procedures (ECPs) were tested in a randomized controlled trial with 40 PwD. It was hypothesized that strengths-based ECPs could improve capacity to consent to a drug treatment in PwD as measured with a semi-structured interview.Results: Against the expectations, no effect of the ECPs on capacity to consent could be found, but the ECPs improved understanding of information in PwD.Conclusion: To empower PwD in clinical settings, however, all aspects of capacity to consent should be targeted with specific aids that are implemented carefully and selectively. More research on possible aids for ECPs is urgently needed in order to enable ethically and legally robust informed consent. In particular, effective ways to improve both reasoning and appreciation are yet to be found.
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Affiliation(s)
- Aoife Poth
- Psychological Ageing Research (PAR), University of Siegen, Siegen, Germany
| | - Susanne Penger
- Psychological Ageing Research (PAR), University of Siegen, Siegen, Germany
| | - Maren Knebel
- Interdisciplinary Ageing Research (IAW), Goethe University Frankfurt, Frankfurt, Germany
| | - Tanja Müller
- Psychological Ageing Research (PAR), University of Siegen, Siegen, Germany
| | - Johannes Pantel
- Institute of General Practice in Frankfurt am Main, Goethe University Frankfurt, Frankfurt, Germany
| | - Frank Oswald
- Interdisciplinary Ageing Research (IAW), Goethe University Frankfurt, Frankfurt, Germany
| | - Julia Haberstroh
- Psychological Ageing Research (PAR), University of Siegen, Siegen, Germany
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Decision-Making in People With Dementia or Mild Cognitive Impairment: A Narrative Review of Decision-Making Tools. J Am Med Dir Assoc 2021; 22:2056-2062.e4. [PMID: 34314703 DOI: 10.1016/j.jamda.2021.06.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This review summarized the applicability of various decision-making tools for helping people with dementia or mild cognitive impairment (MCI) and their families make decisions. DESIGN This study was a narrative literature review. The protocol of this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO ID: CRD42020182259). SETTING AND PARTICIPANTS People with dementia or MCI and their families were included in this study. METHODS This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We searched the Cochrane Library, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Chinese Electronic Periodical Services databases from inception to May 2021. The Joanna Briggs Institute Critical Appraisal Checklists for a variety of study designs were used. RESULTS Topics related to decision-making were categorized as everyday activity decisions or medical treatment decisions. Various types of decision-making tools were identified, and we observed that decision aids can be modified and used for both everyday activity decisions and medical treatment decisions. In addition to highlighting decision aids for specific decisional issues and topics, we also elucidated other validated tools that can be used to facilitate the decision-making process. CONCLUSIONS AND IMPLICATIONS This study highlighted the topics involved in decision-making and using decision-making tools. The current review provides information that can help individuals and health care professionals choose optimal decision-making tools. On the basis of our findings, future studies can determine the most appropriate tools for intervention or outcome measures.
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Haberstroh J, Tesky VA, Pantel J. [Capacity to consent of people with dementia : Insights into the S2k AWMF guidelines 108-001]. DER NERVENARZT 2021; 92:721-728. [PMID: 34181051 DOI: 10.1007/s00115-021-01158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People with dementia often require medical and nursing care and are regularly confronted with the need to make decisions in this respect; however, in practice uncertainty often exists as to whether a person with dementia is capable of providing consent, what procedures should be used to obtain informed consent, how to provide the necessary information and how capacity to consent can be assured. By providing structured practical recommendations, the S2k guidelines "Consent of persons with dementia to medical treatment" (coordinated by the Association of the Scientific Medical Societies of Germany, AWMF, registration number 108-001) provide a first attempt to summarize and update the relevant medical, legal, ethical and psychological requirements that should be satisfied in this respect. This article enables insights into the guidelines and an overview of the most important recommendations.
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Affiliation(s)
- Julia Haberstroh
- Psychologische Alternsforschung, Fakultät II - Dep. Erziehungswissenschaft-Psychologie, Institut für Psychologie, Universität Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Deutschland.
| | - Valentina A Tesky
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Johannes Pantel
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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Kato Y, Matsuoka T, Eguchi Y, Iiboshi K, Koumi H, Nakamura K, Okabe K, Nakaaki S, Furukawa TA, Mimura M, Narumoto J. Anxiety Impacts Consent Capacity to Treatment in Alzheimer's Disease. Front Psychol 2021; 12:685430. [PMID: 34194376 PMCID: PMC8236526 DOI: 10.3389/fpsyg.2021.685430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/18/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to clarify how behavioral and psychological symptoms of dementia (BPSD) and cognitive function affect the decision-making capacity of persons with Alzheimer's disease (AD) in a real informed consent situation about anti-dementia drug prescriptions. The participants were 76 patients with AD. We used the MacArthur Competence Assessment Tool to assess the capacity for consent to treatment (MacCAT-T). We simultaneously used the Mini-Mental State Examination, Executive Interview, Executive Clock Drawing Task, Logical Memory I of the Wechsler Memory Scale-Revised (LM I), LM II, and Neuropsychiatric Inventory (NPI) to assess cognitive function and psychiatric symptoms. We calculated the correlations between the MacCAT-T scores and the demographic, neuropsychological, and psychiatric variables. Once the univariable correlations were determined, we performed simple linear regression analyses to examine if the regression equations were significant. In the final analyses, we incorporated significant variables into stepwise multiple linear regression analyses to determine the most significant predictors of mental capacity. Age (β = −0.34), anxiety (β = −0.27), and LM I (β = 0.26) were significant predictors of “understanding” (adjusted R2 = 0.29). LM II (β = 0.39), anxiety (β = −0.29), and education (β = 0.21) were significant predictors of “understanding of alternative treatments” (adjusted R2 = 0.30). Anxiety (β = −0.36) and age (β = −0.22) were significant predictors of “appreciation” (adjusted R2 = 0.18). Age (β = −0.31) and anxiety (β = −0.28) were significant predictors of explained variance in “reasoning” (adjusted R2 = 0.17). Patients with anxiety had lower scores on all five MacCAT-T subscales: “understanding,” without 3.8 [SD = 1.2] vs. with 2.6 [SD = 1.1]; “understanding of alternative treatments,” without 2.9 [SD = 2.2] vs. with 1.3 [SD = 1.8]; “appreciation,” without 2.9 [SD = 1.1] vs. with 1.9 [SD = 1.2]; “reasoning,” without 4.0 [SD = 2.0] vs. with 2.7 [SD = 1.7]; and “expressing a choice,” without 1.9 [SD = 0.4] vs. with 1.5 [SD = 0.6]. Considering the effects of BPSD, cognitive function, and age/education when assessing consent capacity in persons with AD is important. Reducing anxiety may contribute to improved capacity in persons with AD.
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Affiliation(s)
- Yuka Kato
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoko Eguchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Kiyoko Iiboshi
- Department of Clinical Psychology, Faculty of Human Relations, Shigakukan University, Kagoshima, Japan
| | - Hiroyuki Koumi
- Department of Clinical Psychology, Faculty of Social Welfare, Hanazono University, Kyoto, Japan
| | - Kaeko Nakamura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kayoko Okabe
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shutaro Nakaaki
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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8
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Haberstroh J, Tesky VA, Pantel J. [Capacity to consent of people with dementia : Insights into the S2k AWMF guidelines 108-001]. Z Gerontol Geriatr 2020; 54:167-175. [PMID: 33289856 DOI: 10.1007/s00391-020-01820-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
People with dementia often require medical and nursing care and are regularly confronted with the need to make decisions in this respect; however, in practice uncertainty often exists as to whether a person with dementia is capable of providing consent, what procedures should be used to obtain informed consent, how to provide the necessary information and how capacity to consent can be assured. By providing structured practical recommendations, the S2k guidelines "Consent of persons with dementia to medical treatment" (coordinated by the Association of the Scientific Medical Societies of Germany, AWMF, registration number 108-001) provide a first attempt to summarize and update the relevant medical, legal, ethical and psychological requirements that should be satisfied in this respect. This article enables insights into the guidelines and an overview of the most important recommendations.
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Affiliation(s)
- Julia Haberstroh
- Psychologische Alternsforschung, Fakultät II - Dep. Erziehungswissenschaft-Psychologie, Institut für Psychologie, Universität Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Deutschland.
| | - Valentina A Tesky
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Johannes Pantel
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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9
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De Sabbata K. Dementia, Treatment Decisions, and the UN Convention on the Rights of Persons With Disabilities. A New Framework for Old Problems. Front Psychiatry 2020; 11:571722. [PMID: 33240127 PMCID: PMC7680726 DOI: 10.3389/fpsyt.2020.571722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/22/2020] [Indexed: 11/20/2022] Open
Abstract
The UN Convention on the Rights of Persons with Disabilities has been at the center of considerable debate in the field of mental health. The discussion has caught up in particular after the publication of General Comment No. 1 in which the Committee on the Rights of Persons with Disabilities proposes a particularly radical interpretation of Article 12 of the Convention. Such a document has triggered skeptic and at times hostile reactions especially by psychiatrists, together with some positive comments. In this context, there is sometimes the tendency to focus only on the problematic aspects of the rights and support based model proposed by the CRPD and its Committee, forgetting that also "pre-CRPD" legislations on legal capacity present significant shortcomings. In this contribution I focus on the paradigmatic case of treatment decisions of people living with dementia with the aim to show how a number of provisions emerging from the CRPD and General Comment No. 1 can contribute to overcome the issues characterizing the traditional model of legal capacity and consent to treatment. First, I provide a brief overview of the provisions contained in the CRPD and General Comment No.1, summarizing the debate in this area. Then, I move to the case of treatment decisions of people living with dementia, analysing the main issues posed by the traditional model of capacity still characterizing European legislations. I will show how such problems and the solutions previously advanced by academics and practitioners resound in many ways with those identified by the CRPD and its Committee. In the second part, I analyse one by one the main provisions proposed by the CRPD and the Committee, studying how they can be applied in the area of treatment decisions of people living with dementia. In this context I point out the possible interpretations of the various provisions and their pros and cons, also referring to ongoing initiatives providing an insight on how such norms might work in practice.
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Affiliation(s)
- Kevin De Sabbata
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Pace A, Koekkoek JAF, van den Bent MJ, Bulbeck HJ, Fleming J, Grant R, Golla H, Henriksson R, Kerrigan S, Marosi C, Oberg I, Oberndorfer S, Oliver K, Pasman HRW, Le Rhun E, Rooney AG, Rudà R, Veronese S, Walbert T, Weller M, Wick W, Taphoorn MJB, Dirven L. Determining medical decision-making capacity in brain tumor patients: why and how? Neurooncol Pract 2020; 7:599-612. [PMID: 33312674 DOI: 10.1093/nop/npaa040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Brain tumor patients are at high risk of impaired medical decision-making capacity (MDC), which can be ethically challenging because it limits their ability to give informed consent to medical treatments or participation in research. The European Association of Neuro-Oncology Palliative Care Multidisciplinary Task Force performed a systematic review to identify relevant evidence with respect to MDC that could be used to give recommendations on how to cope with reduced MDC in brain tumor patients. Methods A literature search in several electronic databases was conducted up to September 2019, including studies with brain tumor and other neurological patients. Information related to the following topics was extracted: tools to measure MDC, consent to treatment or research, predictive patient- and treatment-related factors, surrogate decision making, and interventions to improve MDC. Results A total of 138 articles were deemed eligible. Several structured capacity-assessment instruments are available to aid clinical decision making. These instruments revealed a high incidence of impaired MDC both in brain tumors and other neurological diseases for treatment- and research-related decisions. Incapacity appeared to be mostly determined by the level of cognitive impairment. Surrogate decision making should be considered in case a patient lacks capacity, ensuring that the patient's "best interests" and wishes are guaranteed. Several methods are available that may help to enhance patients' consent capacity. Conclusions Clinical recommendations on how to detect and manage reduced MDC in brain tumor patients were formulated, reflecting among others the timing of MDC assessments, methods to enhance patients' consent capacity, and alternative procedures, including surrogate consent.
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Affiliation(s)
- Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J van den Bent
- Department of Neurology, The Brain Tumor Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Helen J Bulbeck
- Brainstrust (The Brain Cancer People), Cowes, Isle of Wight, UK
| | - Jane Fleming
- Department of Palliative Medicine, University Hospital Waterford, Waterford, Ireland
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, Scotland, UK
| | - Heidrun Golla
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany
| | - Roger Henriksson
- Department of Radiation Sciences and Oncology, Umeå University, Umeå, Sweden
| | | | - Christine Marosi
- Department of Internal Medicine I, Clinical Division of Medical Oncology, Medical University of Vienna, Vienna, Austria
| | - Ingela Oberg
- Department of Neuroscience, Cambridge University Hospitals, Cambridge, UK
| | - Stefan Oberndorfer
- Department Neurology, University Clinic St Pölten, KLPU and KLI-Neurology and Neuropsychology, St Pölten, Austria
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Alasdair G Rooney
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland, UK
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Simone Veronese
- Department of Palliative Care, Fondazione FARO, Turin, Italy
| | - Tobias Walbert
- Department of Neurology and Neurosurgery, Henry Ford Health System, Detroit, Michigan, US
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wolfgang Wick
- Neurology Clinic and National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany.,German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neurooncology, German Cancer Research Center, Heidelberg, Germany
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
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11
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Haberstroh J, Müller T. Einwilligungsfähigkeit bei Demenz. Z Gerontol Geriatr 2017; 50:298-303. [PMID: 28534169 DOI: 10.1007/s00391-017-1243-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/19/2017] [Accepted: 04/25/2017] [Indexed: 10/19/2022]
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