Clinical and ethical implications of impaired executive control functions for patient autonomy

The authors identify the clinical and ethical implications of impaired exec utive control functions for patient autonomy. Executive control functions a re processes that orchestrate relatively simple ideas, movements, or action s into complex goal-directed behavior, and impairments in these functions a re becoming more common as the population ages, The authors examine difficu lties that individuals with impair ed executive control functions may have in making treatment decisions and describe a practical, ethically justified framework for making treatment decisions for patients with impairments in these functions. Three components of autonomy are identified-intentionality , understanding, and voluntariness. Intentionality and voluntariness are es pecially affected by impaired executive control functions, Impairments of t hese aspects of autonomy may often be overlooked when only traditional ment al status examinations are employed, with adverse consequences for the heal th of patients wrongly thought to possess intact ability to make, and carry put plans of care. Two case vignettes illustrate the:complexities faced by clinicians intervening with patients who have deficits in:decision-making capacity caused by impaired executive control functions.