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Bioethics and the capacity to consent – A pragmatic approach
cortex 71 (2015) 412
Available online at www.sciencedirect.com
ScienceDirect Journal homepage: www.elsevier.com/locate/cortex
Discussion forum
Bioethics and the capacity to consent e A pragmatic approach Robin G. Morris a,b,* and Najma Khan-Bourne b a b
King's College Institute of Psychiatry, Psychology and Neurosciences, London, UK King's College Hospital NHS Foundation Trust, London, UK
This thought provoking article by Jonathan Baron brings into focus many of the issues concerning ethics and involving people in research studies who may or may not have capacity to consent. It also introduces the notion of predicting capacity by thresholding people for generic capacity using predictive instruments. At least from the UK perspective, it is worth adding that in any clinical situation capacity should always be assessed in the context of the particular decision and the consequences. This ‘contextual approach’ is included in the UK 2005 Capacity Act which specifies four aspects that should be assessed through careful interview, namely whether: (1) the person can understand the particular decision to be made; (2) they are able to retain the information long enough in order to make a decision; (3) they are capable of weighing the information and; (4) they have the ability to communicate their decision (by any means). For capacity to be proven all aspects have to be demonstrated, which is why in practice assessment can problematic and require good clinical skill and judgement. For some studies it clearly not such an issue because patient brain damage is not sufficient to remove capacity and standard
use of information sheets and consent forms suffice; but in other studies, for example, including patients with substantial memory disorder, aphasia or dementia, the level of capacity may be more variable and further work to establish whether there is capacity to assent is appropriate. In such cases we would always recommend the involvement of a clinician who is used to making capacity assessments as part of their clinical practice, at least to advise on individual cases. A useful introduction to this approach is provided by the British Psychological Society Audit Tool for Mental Capacity Assessments, published online in 2010. British Psychological Society Audit Tool for Mental Capacity Assessments: http://www.bps.org.uk/sites/default/files/ documents/audit-tool-mental-capacity-assessments_0.pdf. Mental Capacity Act Code of Practice: 2005: Ref: ISBN 9780117037465.
* Corresponding author. King's College Institute of Psychiatry, Psychology and Neurosciences, London, UK. E-mail address: [email protected] (R.G. Morris). http://dx.doi.org/10.1016/j.cortex.2015.05.024 0010-9452/© 2015 Elsevier Ltd. All rights reserved.
Received 22 May 2015 Accepted 22 May 2015
Available online at www.sciencedirect.com
ScienceDirect Journal homepage: www.elsevier.com/locate/cortex
Discussion forum
Bioethics and the capacity to consent e A pragmatic approach Robin G. Morris a,b,* and Najma Khan-Bourne b a b
King's College Institute of Psychiatry, Psychology and Neurosciences, London, UK King's College Hospital NHS Foundation Trust, London, UK
This thought provoking article by Jonathan Baron brings into focus many of the issues concerning ethics and involving people in research studies who may or may not have capacity to consent. It also introduces the notion of predicting capacity by thresholding people for generic capacity using predictive instruments. At least from the UK perspective, it is worth adding that in any clinical situation capacity should always be assessed in the context of the particular decision and the consequences. This ‘contextual approach’ is included in the UK 2005 Capacity Act which specifies four aspects that should be assessed through careful interview, namely whether: (1) the person can understand the particular decision to be made; (2) they are able to retain the information long enough in order to make a decision; (3) they are capable of weighing the information and; (4) they have the ability to communicate their decision (by any means). For capacity to be proven all aspects have to be demonstrated, which is why in practice assessment can problematic and require good clinical skill and judgement. For some studies it clearly not such an issue because patient brain damage is not sufficient to remove capacity and standard
use of information sheets and consent forms suffice; but in other studies, for example, including patients with substantial memory disorder, aphasia or dementia, the level of capacity may be more variable and further work to establish whether there is capacity to assent is appropriate. In such cases we would always recommend the involvement of a clinician who is used to making capacity assessments as part of their clinical practice, at least to advise on individual cases. A useful introduction to this approach is provided by the British Psychological Society Audit Tool for Mental Capacity Assessments, published online in 2010. British Psychological Society Audit Tool for Mental Capacity Assessments: http://www.bps.org.uk/sites/default/files/ documents/audit-tool-mental-capacity-assessments_0.pdf. Mental Capacity Act Code of Practice: 2005: Ref: ISBN 9780117037465.
* Corresponding author. King's College Institute of Psychiatry, Psychology and Neurosciences, London, UK. E-mail address: [email protected] (R.G. Morris). http://dx.doi.org/10.1016/j.cortex.2015.05.024 0010-9452/© 2015 Elsevier Ltd. All rights reserved.
Received 22 May 2015 Accepted 22 May 2015