LONG-TERM, ASSENTING PSYCHIATRIC-PATIENTS - DECISIONAL CAPACITY AND THE QUALITY OF CARE

The objectives of this study were (1) to investigate whether the relat ionship between functional decisional capacity and the resulting quali ty of treatment posited by the informed consent theory is found in cli nical practice; and (2) to describe the range of decisional impairment s found in long-term psychiatric inpatients who comply with prescribed treatment. Eighty-eight long-term, compliant, psychiatric inpatients, in two public hospitals, who were prescribed antipsychotic medication s were assessed. Following a formal assessment of decisional capacity, subjects were categorized according to level of impairment, using a h ierarchical scheme. All subjects were evaluated for the presence of ab normal involuntary movements. The appropriateness of treatment with an tipsychotic medications was determined using accepted clinical guideli nes. Patients with more serious impairments of decisional capacity wer e more likely to receive inappropriate treatment with antipsychotic me dication; and serious impairments of decisional capacity were common. The study lends empirical support to one of the bases of the doctrine of informed consent: the notion that capable patient involvement in de cisionmaking plays an important role in checking the judgments of trea ting physicians. Remedial measures are needed to protect long-term psy chiatric inpatients with impaired decisional capacity from receiving i nappropriate treatment.