Long-term, assenting psychiatric patients: decisional capacity and the quality of care.
S. K. Hoge and T. C. Feucht-Haviar,
Bull. Amer. Acad. Psychiatry & the Law
23(3): 343-52, 1995.
The objectives of this study were (1) to investigate whether the relationship between functional
decisional capacity and the resulting quality of treatment posited by the informed consent theory is
found in clinical practice; and (2) to describe the range of decisional impairments found in long-term
psychiatric inpatients who comply with prescribed treatment. Eighty-eight long-term, compliant,
psychiatric inpatients, in two public hospitals, who were prescribed antipsychotic medications were
assessed. Following a formal assessment of decisional capacity, subjects were categorized according
to level of impairment, using a hierarchical scheme. All subjects were evaluated for the presence of
abnormal involuntary movements. The appropriateness of treatment with antipsychotic medications
was determined using accepted clinical guidelines. Patients with more serious impairments of
decisional capacity were more likely to receive inappropriate treatment with antipsychotic
medication; and serious impairments of decisional capacity were common. The study lends empirical
support to one of the bases of the doctrine of informed consent: the notion that capable patient
involvement in decisionmaking plays an important role in checking the judgments of treating
physicians. Remedial measures are needed to protect long-term psychiatric inpatients with impaired
decisional capacity from receiving inappropriate treatment.