Department of Psychology, Southern Methodist University, Dallas, USA.
Psychiatry Clin Neurosci. 2015 Aug;69(8):462-71. doi: 10.1111/pcn.12289. Epub 2015 Apr 13.
The objectives of this article are to discuss ethical issues of informed consent in cognitively impaired patients and review considerations for capacity determination. We will also discuss how to evaluate capacity, determine competence, and obtain informed consent when a patient is deemed incompetent. This review emphasizes how to carry out informed consent procedures when capacity is questionable and discusses measures supported for use when determining cognitively impaired patients' ability to consent.
Information was gathered from medical and psychological codes of ethics, peer-reviewed journals, published guidelines from health-care organizations (e.g., American Medical Association), and scholarly books. Google Scholar and PsycINFO were searched for articles related to 'informed consent' and 'cognitive impairment' published in English between 1975 and 2014. Relevant sources referenced in retrieved publications were subsequently searched and reviewed.
We selected 49 sources generated by our search. Sources were included in our review if they presented information related to at least one of our focus areas. These areas included: review of informed consent ethics and procedures, review of cognitive impairment evaluations, recommendations for measuring cognitive capacity, and alternative forms of informed consent.
Patients' cognitive impairments can hinder the ability of patients to understand treatment options. Evaluating the capacity of patients with cognitive impairment to understand treatment options is vital for valid informed consent and should be guided by best practices. Thus, proper identification of patients with questionable capacity, capacity evaluation, and determination of competence, as well as reliance upon appropriate alternative consent procedures, are paramount.
本文旨在讨论认知障碍患者知情同意中的伦理问题，并综述能力判断的相关考虑因素。我们还将讨论当患者被认为无能力时如何评估能力、确定能力和获得知情同意。本综述强调了在能力受到质疑时如何进行知情同意程序，并讨论了在确定认知障碍患者同意能力时支持使用的措施。
信息来自医学和心理学伦理准则、同行评议期刊、医疗保健组织（如美国医学协会）发布的指南以及学术书籍。在 Google Scholar 和 PsycINFO 上搜索了 1975 年至 2014 年间发表的关于“知情同意”和“认知障碍”的英文文章。随后检索并综述了检索出版物中引用的相关来源。
我们共选择了 49 篇检索到的文献。如果这些文献提供了与我们至少一个关注领域相关的信息，则将其纳入我们的综述中。这些领域包括：审查知情同意的伦理和程序、审查认知障碍评估、评估认知能力的建议以及替代形式的知情同意。
患者的认知障碍可能会妨碍患者理解治疗方案的能力。评估认知障碍患者理解治疗方案的能力对于有效的知情同意至关重要，应遵循最佳实践。因此，正确识别能力有疑问的患者、进行能力评估和确定能力以及依赖适当的替代同意程序至关重要。
