Beyond cognition: the role of disordered affective states in impairing competence to
consent to treatment.
H. J. Bursztajn, H. P. Harding, Jr., T. G. Gutheil and A. Brodsky,
Bull. Amer. Acad. Psychiatry & the Law
19(4): 383-8, 1991.
Most of the criteria for competence in current use emphasize cognitive rather than affective
dimensions. Our clinical experience indicates that affective disorders may impair competence in a
detectable and identifiable way. In particular, patients with major affective disorders can retain the
cognitive capacity to understand the risks and benefits of a medication, yet fail to appreciate its
benefits. A case study of a pathologic grief reaction is introduced to illustrate how cognitive and
affective impairments may coexist and require separate remedial strategies for restoration. Further
empirical work on the role of affective disorder in impairing competence is warranted and planned.