Comparison of standards for assessing patients' capacities to make treatment decisions

Abstract

OBJECTIVE: This study investigated the proportion of psychiatric and medical patients who are impaired in their decision-making abilities in relation to each of several major legal standards for determining competence to consent to treatment. METHOD: The subjects were hospitalized patients with diagnoses of schizophrenia (N = 75), major depression (N = 92), and ischemic heart disease (N = 82) and equal numbers of community comparison subjects matched on age, race, gender, education, and occupation. Three instruments measuring abilities related to the legal standards for competence were administered to each group. Impaired functioning was defined as scores two standard deviations below the means for all subjects combined or lower. RESULTS: Although similar percentages of subjects with impaired performance were found for each of the measures, different groups of patients were identified as impaired depending on the measure used. The proportion of patients identified as impaired increased when compound stand...