Medical  decision-making capacity: knowledge, attitudes, and assessment practices of physicians  in Switzerland

Helena Hermann; Manuel Trachsel; Christine Mitchell; Nikola Biller-Andorno

doi:10.4414/smw.2014.14039

Original article

Vol. 144 No. 4142 (2014)

Medical decision-making capacity: knowledge, attitudes, and assessment practices of physicians in Switzerland

Helena Hermann
Manuel Trachsel
Christine Mitchell
Nikola Biller-Andorno

DOI: https://doi.org/10.4414/smw.2014.14039
Cite this as:: Swiss Med Wkly. 2014;144:w14039
Published: 05.10.2014

Summary

OBJECTIVE: Decision-making capacity (DMC) is an indispensable prerequisite for patients’ informed consent and therefore directly related to the right to self-determination. In view of this ethical implication, valid and reliable assessment of DMC is essential to best practice. In general, and with particular regard to the Swiss context, little is known about healthcare practitioners’ knowledge of and attitudes to the concept of DMC, or about their assessment practice. The present study aims to close this gap.

METHOD: A randomised representative sample of 3,500 physicians, including all specialisms and from all parts of Switzerland, were contacted by mail and invited to complete a survey questionnaire, which was specifically designed for the purpose of the study.

RESULTS: A total of 763 questionnaires were included for analysis (response rate: 22.15%). Physicians diverged in their general understanding of DMC as either a dichotomous or a gradual concept, and in relation to the conceptual challenges of decisional relativityand risk-relativity. Along with cognitive abilities, emotional, intuitive, or evaluative factors were acknowledged as important criteria. DMC was most often assessed implicitly: explicit assessments, if conducted, depended mainly on unstructured interviews. A discrepancy was identified between physicians’ perceptions of responsibility and qualification, indicating a related need for more guidance and training.

CONCLUSION: The conceptual and practical challenges of DMC are far from being resolved. There is a clear need for more guidance in this area in the form of guidelines, tools, and training.

References

Buchanan AE, Brock DW. Deciding for others: The ethics of surrogate decision making. Cambridge: Cambridge University Press; 1989.
Trachsel M, Mitchell C, Biller-Andorno N. Decision-making incapacity at the end of life: Conceptual and ethical challenges. Bioethica Forum. 2013;6(1):26–30.
Trachsel M, Hermann H, Biller-Andorno N. Urteilsfähigkeit. Swiss Medical Forum. 2014;14:221–5.
Appelbaum PS, Grisso T. The MacArthur Treatment Competence Study I: Mental illness and competence to consent to treatment. Law and Human Behavior. 1995;19(2):105–26.
Charland LC. Is Mr. Spock mentally competent? Competence to consent and emotion. Philosophy, Psychiatry, Psychology. 1998;5(1):67–81.
Cox White B. Competence to consent. Washington, D.C.: Georgetown University Press; 1994.
Hermann H, Trachsel M, Biller-Andorno N. The role of intuition in medical decision-making capacity. Submitted.
Trachsel M, Hermann H, Biller-Andorno N. Cognitive fluctuation as a challenge for the assessment of decision-making capacity in patients with different forms of dementia. Am J Alzheimers Dis Other Demen. Accepted for publication.
Brock DW. Decisionmaking competence and risk. Bioethics. 1991;5(2):105–12.
Wicclair MR. Patient decision-making capacity and risk. Bioethics. 1991;5(2):91–104.
Lamont S, Jeon YH, Chiarella M. Assessing patient capacity to consent to treatment: An integrative review of instruments and tools. J Clin Nurs. 2013;22:2387–403.
Kim SYH. Evaluation of capacity to consent to treatment and research. Oxford: Oxford University Press; 2010.
Lamont S, Jeon YH, Chiarella M. Health-care professionals’ knowledge, attitudes and behaviours relating to patient capacity to consent to treatment: An integrative review. Nurs Ethics. 2013;20(6):684–707.
Hostettler S, Kraft E. Neuste Zahlen und Übersicht zur Ärztestatistik 2013. Schweizerische Ärztezeitung. 2014;95:467–73.
Grisso T, Appelbaum PS. Assessing competence to consent to treatment: A guide for physicians and other health professionals. New York: Oxford University Press; 1998.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research. 1975;12:189–98.
Grisso T, Appelbaum PS. MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Sarasota, FL: Professional Resource Press; 1998.
Etchells E, Darzins P, Silberfeld M, Singer PA, McKenny J, Naglie G, et al. Assessment of patient capacity to consent to treatment. J Gen Intern Med. 1999;14:27–34.
Fazel S, Hope T, Jacoby R. Assessmet of competence to complete advance directives: Validation of patient centred approach. BMJ. 1999;318:493–7.
Charland LC. Mental competence and value: The problem of normativity in the assessment of decisional capacity. Psychiatry, Psychology, and Law. 2001;8(2):135–45.
Wilks I. The debate over risk-related standards of competence. Bioethics. 1997;11(5):413–26.
Hermann H, Trachsel M, Biller-Andorno N. Physicians’ personal values in determining medical decision-making capacity: A survey study. Submitted.
Kraft E, Hostettler S. FMH-Ärztestatistik: 31858 Ärztinnen und Ärzte garantieren die ärztliche Versorgung. Schweizerische Ärztezeitung. 2013;94:453–7.

How to Cite

1.

Hermann H, Trachsel M, Mitchell C, Biller-Andorno N. Medical decision-making capacity: knowledge, attitudes, and assessment practices of physicians in Switzerland. Swiss Med Wkly [Internet]. 2014 Oct. 5 [cited 2024 Nov. 23];144(4142):w14039. Available from: https://smw.ch/index.php/smw/article/view/1922

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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<< < 1 2

[1] Buchanan AE, Brock DW. Deciding for others: The ethics of surrogate decision making. Cambridge: Cambridge University Press; 1989.

[2] Trachsel M, Mitchell C, Biller-Andorno N. Decision-making incapacity at the end of life: Conceptual and ethical challenges. Bioethica Forum. 2013;6(1):26–30.

[3] Trachsel M, Hermann H, Biller-Andorno N. Urteilsfähigkeit. Swiss Medical Forum. 2014;14:221–5.

[4] Appelbaum PS, Grisso T. The MacArthur Treatment Competence Study I: Mental illness and competence to consent to treatment. Law and Human Behavior. 1995;19(2):105–26.

[5] Charland LC. Is Mr. Spock mentally competent? Competence to consent and emotion. Philosophy, Psychiatry, Psychology. 1998;5(1):67–81.

[6] Cox White B. Competence to consent. Washington, D.C.: Georgetown University Press; 1994.

[7] Hermann H, Trachsel M, Biller-Andorno N. The role of intuition in medical decision-making capacity. Submitted.

[8] Trachsel M, Hermann H, Biller-Andorno N. Cognitive fluctuation as a challenge for the assessment of decision-making capacity in patients with different forms of dementia. Am J Alzheimers Dis Other Demen. Accepted for publication.

[9] Brock DW. Decisionmaking competence and risk. Bioethics. 1991;5(2):105–12.

[10] Wicclair MR. Patient decision-making capacity and risk. Bioethics. 1991;5(2):91–104.

[11] Lamont S, Jeon YH, Chiarella M. Assessing patient capacity to consent to treatment: An integrative review of instruments and tools. J Clin Nurs. 2013;22:2387–403.

[12] Kim SYH. Evaluation of capacity to consent to treatment and research. Oxford: Oxford University Press; 2010.

[13] Lamont S, Jeon YH, Chiarella M. Health-care professionals’ knowledge, attitudes and behaviours relating to patient capacity to consent to treatment: An integrative review. Nurs Ethics. 2013;20(6):684–707.

[14] Hostettler S, Kraft E. Neuste Zahlen und Übersicht zur Ärztestatistik 2013. Schweizerische Ärztezeitung. 2014;95:467–73.

[15] Grisso T, Appelbaum PS. Assessing competence to consent to treatment: A guide for physicians and other health professionals. New York: Oxford University Press; 1998.

[16] Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research. 1975;12:189–98.

[17] Grisso T, Appelbaum PS. MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Sarasota, FL: Professional Resource Press; 1998.

[18] Etchells E, Darzins P, Silberfeld M, Singer PA, McKenny J, Naglie G, et al. Assessment of patient capacity to consent to treatment. J Gen Intern Med. 1999;14:27–34.

[19] Fazel S, Hope T, Jacoby R. Assessmet of competence to complete advance directives: Validation of patient centred approach. BMJ. 1999;318:493–7.

[20] Charland LC. Mental competence and value: The problem of normativity in the assessment of decisional capacity. Psychiatry, Psychology, and Law. 2001;8(2):135–45.

[21] Wilks I. The debate over risk-related standards of competence. Bioethics. 1997;11(5):413–26.

[22] Hermann H, Trachsel M, Biller-Andorno N. Physicians’ personal values in determining medical decision-making capacity: A survey study. Submitted.

[23] Kraft E, Hostettler S. FMH-Ärztestatistik: 31858 Ärztinnen und Ärzte garantieren die ärztliche Versorgung. Schweizerische Ärztezeitung. 2013;94:453–7.