Assessment of decision-making capacity at the end of life
05.2012 – 04.2015
Whether or not a person is competent to make decisions at the end of life is of great importance; for instance, decision-making incapacity can be the prerequisite for the patient’s living will taking effect. This study examines conditions and possibilities of the medical assessment of decision-making capacity.
The last phase of a person’s life is often accompanied by a state of decision-making incapacity (mental incapacity and decision-making inability). But precisely at the end of life, there are often complex decision-making situations that require mental capacity and decision-making ability. This means that physicians have to assess whether a patient is competent. If physicians determine that a patient is not (or no longer) competent to make a health care decision, this has consequences for the further way of proceeding. It may trigger the use of the patient’s living will, or a person with a medical power of attorney for the patient will be consulted.
In a first phase of this study, the literature on the topic will be reviewed and existing assessment instruments analysed. In a second phase, 300 physicians will be surveyed to investigate empirically what the current assessment practice in Switzerland is. The third phase consists of integration and ethical discussion of the results and proposals for the drafting of guidelines. This phase will be monitored by a multidisciplinary, international panel of experts. In addition, the researchers also plan to develop a training module for physicians.
This study will make an important contribution towards the establishment of national standards for the assessment of decision-making capacity. These are important in view of the increasing acceptance of patient self-determination. The results can be helpful for the development of future guidelines, for example by the Swiss Academy of Medical Sciences.
Médecine, Psychologie, Autres disciplines
Institute of Biomedical Ethics, University of Zurich
Prof. Dr. Dr. Nikola Biller-Andorno; Dr. Manuel Trachsel
Christine Mitchell, Harvard Medical School; Prof. Paul S. Appelbaum, Columbia University
decision-making capacity, competence, assessment, end of life, palliative care, ethics
Hermann, H., Trachsel, M., Mitchell, C., & Biller-Andorno, N. (2014). Medical decision-making capacity: Knowledge, attitudes, and assessment practices of physicians in Switzerland. Swiss Medical Weekly.
Trachsel, M., Hermann, H., & Biller-Andorno, N. (2014). Cognitive fluctuation as a challenge for the assessment of decision-making capacity in patients with different forms of dementia. American Journal of Alzheimer’s Disease and Other Dementias. Epub ahead of print.
Trachsel, M., Hermann, H., & Biller-Andorno, N. (2014). Urteilsfähigkeit: Ethische Relevanz, konzeptuelle Herausforderung und ärztliche Beurteilung [Decision-making capacity: Ethical relevance, conceptual challenge, and medical assessment]. Swiss Medical Forum, 14(11), 221-225.
Trachsel, M., Mitchell, C., & Biller-Andorno, N. (2013). Decision-making incapacity at the end of life: conceptual and ethical challenges. Bioethica Forum, 6(01), 26-30.
Trachsel, M., Mitchell, C., & Biller-Andorno, N. (2013). Advance directives in the area of conflict between individualism and paternalism. In P. Lack, N. Biller-Andorno, & S. Brauer (Hrsg.). Advance directives, International Library of Ethics, Law, and the New Medicine 54. Dordrecht: Springer Science+Business Media.
Trachsel, M., Hermann, H., Biller-Andorno, N. (2013, November). Risk-relativity of decision-making capacity in palliative care. Poster presented at the national conference “Palliative care: Knowing more, understanding better”. Inselspital, Bern, Switzerland.