Kontos Nicholas, Querques John, Freudenreich Oliver
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA..
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Psychosomatics. 2015 May-Jun;56(3):217-26. doi: 10.1016/j.psym.2014.11.004. Epub 2014 Nov 21.
The 4-abilities model of decision-making capacity is vulnerable to constricted application and teaching.
The authors attempt to assert the fundamentally clinical nature of capacity evaluations, while acknowledging that the concept of decision-making capacity must be legally grounded.
Relevant aspects of clinical care are examined and emphasized as they apply to the evaluation of capacity for medical decision making.
Accessing patients' maximal abilities, attending to noncognitive aspects of choice, and identifying diagnostic explanations for patients' difficulties are important components of these assessments.
The evaluation of medical decision-making capacity is not a purely forensic task; it is enhanced by an approach that bridges the clinical-forensic divide.
决策能力的四能力模型容易受到应用和教学受限的影响。
作者试图强调能力评估的根本临床性质，同时承认决策能力的概念必须有法律依据。
审视并强调临床护理的相关方面，因为它们适用于医疗决策能力的评估。
了解患者的最大能力、关注选择的非认知方面以及识别患者困难的诊断性解释是这些评估的重要组成部分。
医疗决策能力的评估并非纯粹的法医任务；采用弥合临床与法医分歧的方法可增强评估效果。
