CLINICIAN JUDGMENT OF CAPACITY OF NURSING-HOME PATIENTS TO GIVE INFORMED CONSENT

Objective: The study determined the rate of incapacity to give informe d consent for medical treatment among patients admitted to a nursing h ome and assessed whether clinical staff members recognized this incapa city and whether they used alternative means to provide surrogate deci sion making for their patients' treatment. Methods: After 44 patients admitted to a nursing home affiliated with a major teaching hospital g ave oral consent, two standardized tests, the Hopkins Competency Asses sment Test (HCAT) and the Mini Mental State Examination (MMSE) were ad ministered to them. Later a researcher blind to the test results revie wed subjects' clinical records to determine whether staff recognized a ny incapacity in giving informed consent for medical treatment. Result s: Twenty of 44 subjects were identified by the HCAT as incompetent to give informed consent for medical treatment. Clinical staff had ident ified 13 of those subjects as clinically incompetent, None of the subj ects whom clinical staff identified as clinically incompetent was prov ided with surrogate decision makers in accordance with procedures outl ined in state law Conclusions: The prevalence of incapacity to give in formed consent in the nursing home population was high. Clinical scree ning by staff did not identify all clinically incompetent patients, an d staff had unresolved conflicting opinions about individual patients' capacity to give informed consent. Even when staff recognized a patie nt's incapacity to give informed consent, proper legal procedures for appointing surrogate decision makers were not followed.