The MacArthur Treatment Competence Study. I: Mental illness and competence to consent to treatment.
Abstract
This is the first of three papers reporting the results of the MacArthur Treatment CompetenceStudy, a project designed to develop reliable and valid information with which to address clinical and policy questions regarding the abilities of persons with mental illness to make decisions about psychiatric treatment. Four commonly applied legal standards for determining decision-making competence are described: abilities to communicate a choice, understand relevant information, appreciate the nature of the situation and its likely consequences, and rationally manipulate information. Previous research related to the capacities of persons with mental illness in relation to these standards is reviewed and critiqued. The principles underlying the design of the MacArthur Treatment Competence Study are described.
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MacArthur Competence Assessment Tools exist for consenting to treatment, to research participation and to criminal adjudication, and assess decision-making capacity across understanding, reasoning, appreciation and expressing a choice.
“Commercially available tools have been developed for consenting to treatment (MacCAT-T), consenting to participation in clinical research (Mac-CAT-CR), and participating in criminal adjudication (MacCAT-CA).”
From Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory? (2019) · cites this paper as [6]
MacArthur Competence Assessment Tools exist for consenting to treatment, to research participation and to criminal adjudication, and assess decision-making capacity across understanding, reasoning, appreciation and expressing a choice.
“Commercially available tools have been developed for consenting to treatment (MacCAT-T), consenting to participation in clinical research (Mac-CAT-CR), and participating in criminal adjudication (MacCAT-CA).”
From Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory? (2019) · cites this paper as [5]
Mental illness often negatively affects a person's decision-making capacity.
“The main empirical premise upon which this argument is based -i.e. that decision-making capacity is often negatively affected by mental illness -is fairly uncontroversial, as it has been corroborated in a number of empirical studies [5][6][7][8].”
From Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory? (2019) · cites this paper as [6]
Mental illness often negatively affects a person's decision-making capacity.
“The main empirical premise upon which this argument is based -i.e. that decision-making capacity is often negatively affected by mental illness -is fairly uncontroversial, as it has been corroborated in a number of empirical studies [5][6][7][8].”
From Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory? (2019) · cites this paper as [5]
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References 111 · Cited by 424
- Authors
- Appelbaum, P. S., & Grisso, T.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Venue
- Law and Human Behavior
- Published
- 1995-04
- Volume
- 19
- Issue
- 2
- Pages
- 105-126
- ISSN
- 0147-7307 (ISSN-L)
- 1573-661X
- OpenAlex
- W1987023267
- Cited by
- 424
- References
- 111
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 4 · 2023: 12 · 2022: 14 · 2021: 15 · 2020: 14 · 2019: 16 · 2018: 16 · 2017: 19 · 2016: 15 · 2015: 15 · 2014: 18 · 2013: 18 · 2012: 10
- FWCI
- 20.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Law and Human Behavior (publishedVersion)
- PubMed (publishedVersion)
- The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics in Clinical Research
- Keywords
- mental illness, decision-making capacity, informed consent
- MeSH terms
- Cognition, Communication, Decision Making, Depressive Disorder, Evaluation Studies as Topic, Heart Diseases, Humans, Informed Consent, Institutionalization, Jurisprudence, Methods, Patients, Psychiatry, Reference Standards, Research, Research Design, Schizophrenia, United States, Treatment Refusal, Mental Competency, Mentally Ill Persons, Persons with Psychiatric Disorders, Comprehension, Control Groups, Empirical Research
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