The MacArthur Treatment Competence Study. III: Abilities of patients to consent to psychiatric and medical treatments.

TLDR

The study discusses policy implications for protecting the rights of mentally ill patients at risk of incompetent treatment decisions. Researchers administered three competence assessment instruments to six groups, including hospitalized schizophrenia, depression, and heart disease patients and matched non‑ill community controls. Only a minority of participants across all groups displayed significant decisional impairments, with schizophrenia and depression patients showing poorer understanding, reasoning, and illness appreciation, especially pronounced in schizophrenia.

Abstract

Three instruments assessing abilities related to legal standards for competence to consent to treatment were administered to 6 groups: patients recently hospitalized for schizophrenia, major depression, and ischemic heart disease, as well as three groups of non-ill persons in the community who were matched with the hospitalized patients on age, gender, race, and socioeconomic status. Significant impairments in decisional abilities were found for only a minority of persons in all groups. Both the schizophrenia and depression groups manifested poorer understanding of treatment disclosures, poorer reasoning in decision making regarding treatment, and a greater likelihood of failing to appreciate their illness or the potential benefits of treatment. Deficits were more pronounced, however, among patients with schizophrenia. Implications are discussed for policy designed to protect the rights and welfare of patients with mental illness who are at risk of incompetent refusal or consent when making treatment decisions.