Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals

One of the most challenging tasks facing clinicians today is the assessment of patients' capacities to consent to treatment. The protection of a patient's right to decide, as well as the protection of incompetent patients from the potential harm of their decisions, rests largely on clinicians' abilities to judge patients' capacities to decide what treatment they will receive. However, confusing laws and the complicated ethical issues surrounding the concept of competence to consent have made the process of competence assessment intimidating for many clinicians. Health professionals--physicians, medical students, residents, nurses, and mental health practitioners--have long needed a concise guidebook that translates the issues for practice. That is what this book accomplishes. This volume is the product of an eight-year study of patients' capacities to make treatment decisions--the most comprehensive research of its kind. The authors describe the place of competence in the doctrine of informed consent, analyze the elements of decision-making, and show how assessments of competence to consent to treatment can be conducted within varied general medical and psychiatric treatment settings. The book explains how assessments should be conducted and offers detailed, practice-tested interview guidelines to assist medical practitioners in this task. Numerous case studies illustrate real-life applications of the concepts and methods discussed. Grisso and Appelbaum also explore the often difficult process of making judgments about competence and describe what to do when patients' capacities are limited. A timely, practical handbook relevant to every medical specialty, Assessing Competence to Consent to Treatment will benefit a wide array of medical practitioners--including physicians, medical students, residents, nurses, and other allied health professionals--who need to assess the mental competence of patients in their everyday practice. It will also interest ethicists and moral philosophers, as well as geriatricians and clinical psychologists working with cognitively impaired patients.

Table of Contents:
1: Why Competence is Important: The Doctrine of Informed Consent 2: Thinking About Competence 3: Abilities Related to Competence 4: When Patients' Decision Making Should be Assessed 5: Assessing Patients' Capacities to Consent to Treatment 6: Using the MacArthur Competence Assessment Tool - Treatment 7: Making Judgements About Patients' Competence 8: Substitute Decision Making for Incompetent Patients

About the Author :
Thomas Grisso, Ph.D. is Professor of Psychiatry and Director of Forensic Training and Research at the University of Massachusetts Medical Center. Paul S. Appelbaum, M.D., is the A.F. Zeleznik Professor of Psychiatry, and Chairman of the Department of Psychiatry at the University of Massachusetts Medical Center. His books include: Trauma and Memory: Clinical and Legal Controversies (OUP, 1997) and Almost a Revolution: Mental Health Law and the Limits of Change (OUP, 1994).

Review :
"A clinical masterpiece. Drs. Grisso and Appelbaum have written a practical, clinical gude to assessing an individual's competence to consent to treatment. Their scholarly reviews and focused clinical vignettes make this volume an essential element of all physicians' personal libraries."--Thomas N. Wise, M.D., Chairman, Department of Psychiatry, Georgetown University "...an insanely competent exercise in logic and clarity."--The Journal of Clinical Research Best Practices "Every few decade comes a book so influential that the history of the entire field is divided into 'before' and 'after'. Assessing Competence to Consent to Treatment is such a book: a clinical, legal, and scientific accomplishment so complete that it will be the odd reader who does not turn the final page and think, 'this is what scholarship should be.' A staggering accomplishment!"--John Monahan, Ph.D., Doherty Professor of Law, University of Virginia "Those who teach about informed consent, as well as those who consult on this issue, routinely turn to the works of Paul Appelbaum and Tom Grisso for guidance. Their previous academic work in this field has been excellent and this new volume is no exception....The emphasis in this book is on the clinical aspects of informed consent. The chapters are structured with helpful guidance in dealing with the dilemmas that often arise when competence is assessed....This book represents yet another significant contribution by Grisso and Appelbaum to the field of law and medicine. More importantly, and most successfully, it is a useful clinical volume that should be readily available to all consultation clinicians."--Psychosomatics "...a well-elaborated and thorough description of the subsequent steps that have to be taken to minimize the risk of neglecting important aspects in this complicated procedure. Therefore this book is essential for physicians and clinical psychologists working with cognitively impaired patients."--Medicine, Health Care and Philosophy "A clinical masterpiece. Drs. Grisso and Appelbaum have written a practical, clinical guide to assessing an individual's competence to consent to treatment. Their scholarly reviews and focused clinical vignettes make this volume an essential element of all physicians' personal libraries."--Thomas N. Wise, M.D., Chairman, Department of Psychiatry, Georgetown University "Every few decade comes a book so influential that the history of the entire field is divided into 'before' and 'after'. Assessing Competence to Consent to Treatment is such a book: a clinical, legal, and scientific accomplishment so complete that it will be the odd reader who does not turn the final page and think, 'this is what scholarship should be.' A staggering accomplishment!"--John Monahan, Ph.D., Doherty Professor of Law, University of Virginia "This is a very practical and useful book for any clinician who provides treatment to patients for whom competence to consent is an issue. It is quite user-friendly, with convenient chapter summaries and many illustrative clinical vignettes."--Doody's Journal Noted in Annals of Internal Medicine "In daily practice, it is physicians who frequently determine whether patients lack decision-making capacity. Assessing Competence to Consent to Treatment is a concise, lucid, wise, and practical book on how to do so....This book provides extremely useful guidance."--The New England Journal of Medicine "This book will appeal to anyone who has ever struggled with difficult decisions on the treatment of individuals who are dubiously competent to consent. Using frequent and relevant clinical examples, the authors, who are acknowledged experts in biomedical ethics, explore the concepts on which competency to consent is founded."--Annals of the Royal College of Physicians and Surgeons of Canada "Once in a great while comes a book that is of major significance in a professional field. This relatively small book is one of those seminal works. The authors, both nationally known figures in the field of law and mental health, present a very practical guide, written in a clear, concise, and useful manner, to assessing patients' competency to consent to treatment....Together, they have accomplished a tour de force in the field of psychiatry and law."--Psychiatric Services "Grisso and Appelbaum have given us a complete and concise description of the law, theoretical considerations, and an operational model for determining competency to consent to treatment . . . . This work is truly a guide for the assessment of competence to consent to treatment. Anyone who develops an understanding of what is written here will be competent to determine this type of competency. Even those who think they know how to do it can benefit from reading this book. It's like a brief refresher course and highly recommended." The Journal of Nervous and Mental Disease "This book, written by two authors who have written extensively about the topic of health care decision-making and issues of capacity/competence, provides an in-depth history and delineation of the process of informed consent." -- Louise Schmitt, PhD, Clinical Gerontologist "The authors, using superb clinical vignettes, flesh out the use of these elements, discussing them in the context of the demainds of the situation. This is the subject of the first half of the book: an even-handed and lucid discussion of the anatomy and physiology of the consent process. The second half is a data-based application of these principles. The utility of the instrument lies in the validity of the underlying concepts. The ease of administration, the reliability of an assessment protocol, and the fact of making a record. From a preventive risk-management point of view, such information is gold." -- The Journal of Psychiatry and Law, 28/Summer 2000 "It would be hard to find greater authorities internationally on this topic than Thomas Grisso and Paul S. Appelbaum of the Department of Psychiatry, University of Massachusetts. Their book Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals provides all you could possibly want to know about the principle of consent to treatment and what is required to be able to give valid consent.""Where Grisso and Appelbaum are ground-breaking is it in their introduction of a structured clinical instructment to assess capacity.""This book provides the most comprehensive examination of the topic available and more than enough preparation to cope with the increased importance of this clinical topic."--Journal of Forensic Psychiatry