Informed consent and neuroanatomic correlates of intentionality and voluntariness among psychiatric patients

The authors examine the less-studied components of patients' autonomous dec ision making, or decisional autonomy, in the light of current research in p sychiatry and neuropsychology and developments in the construct of informed consent. The three components of decisional autonomy-understanding, intent ionality, and noncontrol or voluntariness-are related to clinical construct s in psychiatry and neuropsychology, in particular to executive control fun ctions. The authors review studies that examine deficits in prefrontal cere bral function in schizophrenia, depression, and some anxiety disorders that are related to intentionality and voluntariness. Assessment of decisional autonomy should encompass evaluation of impaired intentionality and volunta riness, not simply impaired understanding. The main response to finding suc h impairments should be to provide treatment to ameliorate them. New strate gies for psychiatric care should be developed to address the clinical chall enges of an increasingly complex view of decisional autonomy.