Ascertaining Capacity to Consent: A survey of approaches used by psychiatrists
Abstract
Doctors are increasingly criticised for imposing treatment without adequate consent. Approaches used by psychiatrists (of all grades and in all sub-specialities) to assess capacity to consent in a large west London psychiatric trust were surveyed with a questionnaire. The questionnaire consisted of two case-vignettes and a series of seven questions (six with forced choice yes/no answers and one with an open-ended answer). The responding psychiatrists' assessment of capacity and that judged by the research psychiatrist were compared. There was no relationship between age, sex, duration of experience in psychiatry, grade and speciality, and (i) the respondents' assessment of capacity and (ii) the research psychiatrist's assessment of capacity. The kappa concordance between the responding psychiatrists' assessment of capacity and that judged by the research psychiatrist was 0.17 (P=0.067) and 0.12 (P>0.05) for vignettes 1 and 2 respectively. Individual psychiatrists appear to variably interpret and apply the criteria for assessment of capacity to consent.
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Studies have shown physicians frequently disagree on the competency of psychiatric patients who request assisted death - inter-rater reliability of capacity judgments by clinicians without the aid of standardized assessments is low, and modest evidence suggests clinicians tend to overestimate capacity.
“Studies have shown physicians frequently disagree on the competency of psychiatric patients who request assisted death — inter-rater reliability of capacity judgments by clinicians without the aid of standardized assessments is low, and modest evidence suggests clinicians tend to overestimate capacity (6, 47–50).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [50]
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Assessing Decisional Capacity for Clinical Research or Treatment: A Review of Instruments
Dunn, L. B., Nowrangi, M. A., Palmer, B. W., Jeste, D. V., & Saks, E. R. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.8.1323 · Cited by 464 · see citing works
Healthcare Decision Making and the Law: Autonomy, Capacity and the Limits of Liberalism
(2011) · International Journal of Health Care Quality Assurance · doi:10.1108/ijhcqa.2011.06224eaa.015 · Cited by 53 · see citing works
Elzakkers, I. F. F. M., Danner, U. N., Grisso, T., Hoek, H. W., & van Elburg, A. A. (2018) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2018.02.001 · Cited by 30 · see citing works
“…in patients (Lepping, Sambhi, & Williams-Jones, 2010) and has low inter rater reliability (Kitamura & Kitamura, 2000; Marson, McInturff, Hawkins, Bartolucci, & Harrell, 1997; Shah & Mukherjee, 2003), i.e. two clinicians have low agreement in their assessment of mental capacity in the same patient.”
BackgroundDefending the indefensible? Psychiatry, assisted suicide and human freedom
Parker, M. (2013) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2013.06.007 · Cited by 23 · see citing works
Shaffer, C. S., Cook, A. N., & Connolly, D. A. (2016) · Psychology, Public Policy, and Law · doi:10.1037/law0000082 · Cited by 21 · see citing works
Assisted death in eating disorders: a systematic review of cases and clinical rationales
Roff, C., & Cook-Cottone, C. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1431771 · Cited by 16 · see citing works
“…physicians frequently disagree on the competency of psychiatric patients who request assisted death — inter-rater reliability of capacity judgments by clinicians without the aid of standardized assessments is low, and modest evidence suggests clinicians tend to overestimate capacity (6, 47 – 50).”
BackgroundShah, A. K., Banner, N. F., Heginbotham, C., & Fulford, B. K. W. M. (2009) · International Psychogeriatrics · doi:10.1017/s1041610209990202 · Cited by 13 · see citing works
“, 2008) and similar to another questionnaire study of consultant psychiatrists pertaining to DMC (Shah and Mukherjee, 2003).”
ResultSelf-citationWords and reasons: psychiatry and assisted suicide
Parker, M. (2012) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867411434334 · Cited by 9 · see citing works
“…the legal assumption and definition of capacity (PVM, 2000), from considerable variability in capacity assessment (Kim et al., 2011; Markson et al., 1994; Shah and Mukherjee, 2003), or from the influence of the gravity of clinical situations on their judgments of capacity (McKinnon et al., 1989).”
Background(In) capacity legislation in practice
McCulloch, J. (2009) · Psychiatric Bulletin · doi:10.1192/pb.bp.107.019323 · Cited by 7 · see citing works
Shah, A. K., Banner, N. F., Heginbotham, C., & Fulford, B. K. W. M. (2010) · Medicine Science and the Law · doi:10.1258/msl.2010.010014 · Cited by 4 · see citing works
Self-citationShah, A. K., Banner, N. F., Newbigging, K., Heginbotham, C., & Fulford, B. K. W. M. (2009) · Ethnicity and Inequalities in Health and Social Care · doi:10.1108/17570980200900010 · Cited by 3 · see citing works
Self-citationCapacity assessment in practice
Donnelly, M. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511760679.005
- Authors
- Shah, A., & Mukherjee, S.
- Affiliations
- West London Mental Health NHS Trust (GB)
- ORCID
- Shah, Ajit
- Venue
- Medicine Science and the Law
- Publisher
- SAGE Publications
- Published
- 2003-07
- Volume
- 43
- Issue
- 3
- Pages
- 231-235
- ISSN
- 0025-8024 (ISSN-L)
- 2042-1818
- OpenAlex
- W1993099409
- Cited by
- 12
- References
- 0
- Citations by year
- 2024: 1 · 2018: 1 · 2016: 1 · 2013: 1 · 2012: 1
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Medicine Science and the Law (publishedVersion)
- PubMed (publishedVersion)
- 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 › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- capacity to consent, informed consent, psychiatric treatment, interobserver agreement, case vignettes, mental capacity law, coercion in mental health care
- MeSH terms
- Adult, Aged, Female, Forensic Psychiatry, United Kingdom, Humans, Informed Consent, Male, Middle Aged, Surveys and Questionnaires, Mental Competency
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