2005 Fiscal Year Final Research Report Summary
Research on assessment of mental capacity for informed-consent and appointment system for substituted decision maker
| Project/Area Number |
15591251
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Psychiatric science
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| Research Institution | Toyo University (2005)
Tokyo Metropolitan Organization for Medical Research (2003-2004) |
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Principal Investigator |
SHIRAISHI Hiromi Toyo University, Faculty of Human Life Design, Professor, ライフデザイン学部, 教授 (80291144)
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| Co-Investigator(Kenkyū-buntansha) |
IGARASHI Yoshito Toyo University, Tokyo Institute of Psychiatry, Chief Researcher, 主任研究員 (40332374)
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| Project Period (FY) |
2003 – 2005
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| Keywords | Mental Capacity / Informed Consent / Assessment of Mental Capacity / Substituted Decision Making / Mentally Disordered Patients / Consciousness Disturbance / Intellectually Disordered Patients / Aged People with Dementia |
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| Research Abstract |
According to the Doctrine of Informed Consent, a competent patient's decisions about accepting or rejecting proposed treatment are respected. And an appropriate substituted decision maker must decide for those patients who are incompetent to consent to treatment. Now there are few medical professionals who will ignore this Doctrine in many countries of the world. In Japan as well, the Doctrine is respected but there seems to be no well known tool such as MacCAT-T by Grisso and Appelbaum(1998) for assessing competence of the patient, nor the system for selecting a substituted decision maker when the patient is assessed as incompetent
In 2004, the authors conducted a survey by sending a questionnaire to Japanese internists, psychiatrists, neurologists and neurosurgeons in terms of assessing competence and selecting substituted decision maker in their clinical settings. The authors adopted 4 possible situations which corresponds to 4 different types of related abilities (expressing a choice, understanding, appreciation, and reasoning) and 4 different candidate for substituted decision maker (a family member, superintendent of the group-home, care-taker of the district, and a member of a ambulance personnel), respectively. Among the 295 respondents, there were 42 internists, 90 psychiatrists, 62 neurologists, and 81 neurosurgeons. Answers of medical professionals differed in questions to assess competence to consent to treatment, and to select an appropriate substituted decision maker. Many answered that there should be one or more authorized tool(s) for assessment and the necessity to establish a third party organization to decide when there is no appropriate substituted decision maker.
The authors discuss it is high time to pay more attention for patients without competence to consent to treatment.
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