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Decisional Capacity After Dark: Is Autonomy Delayed Truly Autonomy Denied?

Published online by Cambridge University Press:  27 June 2023

Jacob M. Appel Open the ORCID record for Jacob M. Appel [Opens in a new window]
Jacob M. Appel*
Affiliation:
Professor of Psychiatry and Medical Education, Director of Ethics Education in Psychiatry, Assistant Director, Academy for Medicine & the Humanities, Attending Physician, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
*
Email: jacobmappel@gmail.com
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Abstract

The model for capacity assessment in the United States and much of the Western world relies upon the demonstration of four skills including the ability to communicate a clear, consistent choice. Yet such assessments often occur at only one moment in time, which may result in the patient expressing a choice to the evaluator that is highly inconsistent with the patient’s underlying values and goals, especially if a short-term factor (such as frustration with the hospital staff) distorts the patient’s preferences momentarily. These challenges are particularly concerning in cases, which arise frequently in hospital settings, in which patients demand immediate self-discharge, often during off-hours, while faced with life-threatening risks. This paper examines the distinctive elements that shape such cases and explores their ethical implications, ultimately offering a model for such situations that can be operationalized.

Keywords

Capacityagainst medical advicepsychiatryconsult-liaison psychiatry
Type
Research Article
Information
Cambridge Quarterly of Healthcare Ethics , Volume 33 , Issue 2 , April 2024 , pp. 260 - 266
Copyright
© The Author(s), 2023. Published by Cambridge University Press

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References

Notes

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14. See note 7, Garrett et al. 2023.

15. See note 4, Appelbaum, Grisso 1988.