{"title":"A Values-Based Approach to Capacity Assessment.","authors":"Jacob M Appel","doi":"10.1080/01947648.2022.2162171","DOIUrl":null,"url":null,"abstract":"<p><p>The dominant approaches to assessing patients for decisional capacity in the clinical setting, the \"four skills\" and \"sliding scale\" models, emerged in the 1970s and 1980s against a backdrop of medical paternalism and reflect their origins in law and forensic psychiatry. They privilege rationality and require the ability to defend one's decisions with knowledge and argument. Unfortunately, these approaches place a heavy burden upon patients who may hold preferences consistent with their underlying values but may not possess the education or reasoning skills necessary to meet the heavy burden imposed by current capacity standards. This article reviews the shortcomings of the dominant models. Then the article proposes a novel value-based approach to capacity assessment that places primary emphasis upon the patient's underlying and longstanding values and the concordance of those values with the patient's current wishes and preferences.</p>","PeriodicalId":44014,"journal":{"name":"Journal of Legal Medicine","volume":"42 1-2","pages":"53-65"},"PeriodicalIF":0.3000,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"4","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Legal Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/01947648.2022.2162171","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"LAW","Score":null,"Total":0}
引用次数: 4
Abstract
The dominant approaches to assessing patients for decisional capacity in the clinical setting, the "four skills" and "sliding scale" models, emerged in the 1970s and 1980s against a backdrop of medical paternalism and reflect their origins in law and forensic psychiatry. They privilege rationality and require the ability to defend one's decisions with knowledge and argument. Unfortunately, these approaches place a heavy burden upon patients who may hold preferences consistent with their underlying values but may not possess the education or reasoning skills necessary to meet the heavy burden imposed by current capacity standards. This article reviews the shortcomings of the dominant models. Then the article proposes a novel value-based approach to capacity assessment that places primary emphasis upon the patient's underlying and longstanding values and the concordance of those values with the patient's current wishes and preferences.
期刊介绍:
The Journal of Legal Medicine is the official quarterly publication of the American College of Legal Medicine (ACLM). Incorporated in 1960, the ACLM has among its objectives the fostering and encouragement of research and study in the field of legal medicine. The Journal of Legal Medicine is internationally circulated and includes articles and commentaries on topics of interest in legal medicine, health law and policy, professional liability, hospital law, food and drug law, medical legal research and education, the history of legal medicine, and a broad range of other related topics. Book review essays, featuring leading contributions to the field, are included in each issue.