Do Consultation Psychiatrists, Forensic Psychiatrists, Psychiatry Trainees, and Health Care Lawyers Differ in Opinion on Gray Area Decision-Making Capacity Cases? A Vignette-Based Survey

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• 作者：James Armontrout ; M.D.^a ; ^b ; ^c ; ^{jarmontr@bidmc.harvard.edu" class="auth_mail" title="E-mail the corresponding author} ; David Gitlin ; M.D.^a ; Thomas Gutheil ; M.D.^b ; ^c
• 关键词：decision-making capacity ; forensic psychiatrists ; capacity determinations.
• 刊名：Psychosomatics
• 出版年：2016
• 出版时间：September-October 2016
• 年：2016
• 卷：57
• 期：5
• 页码：472-479
• 全文大小：194 K

文摘

Previous research in the area of medical decision-making capacity has demonstrated relatively poor agreement between experienced evaluators in “gray area” cases. We performed a survey to determine the level of agreement about gray area decision-making capacity case scenarios within and between individuals of different professional backgrounds.

Method

Participants received a survey consisting of 3 complicated decision-making capacity vignettes with an accompanying “yes/no” question regarding capacity and a certainty scale for each vignette. Participants were identified from mailing lists of professional organizations and local hospitals. We received responses from psychiatry trainees, consultation-liaison psychiatrists, forensic psychiatrists, and lawyers with experience in health care law. Results were analyzed using SPSS.

Results

Across the 3 vignettes, the percentage agreeing that the individual described had capacity to refuse medical treatment ranged between 35% and 40% for trainees, 33% and 67% for consult psychiatrists, 41% and 76% for forensic psychiatrists, and 40% and 83% for health care lawyers. Only question 2 reached significance between-group differences (Pearson χ² = 11.473, p < 0.01). Across vignettes, trainees were less likely to consider patients to have capacity for decision-making than were forensic psychiatrists and lawyers.

Conclusions

As found in previous research, agreement among experienced evaluators appears generally low in gray area capacity cases. It is noteworthy that individuals of different professional backgrounds at times offer divergent between-group opinions on capacity.