Rodgers Joshua J, Kass Joseph S
Continuum (Minneap Minn). 2018 Jun;24(3, BEHAVIORAL NEUROLOGY AND PSYCHIATRY):920-925. doi: 10.1212/CON.0000000000000600.
Medical decision-making capacity, the patient's ability to exercise autonomy reasonably, is an essential component of both informed consent and informed refusal. The assessment of medical decision-making capacity is thus fundamental to the ethical practice of medicine. Medical decision-making capacity is not all or nothing but rather exists on a continuum and should be assessed on a decision-by-decision basis. Alzheimer disease and other neurocognitive disorders can affect a patient's medical decision-making capacity and may pose special challenges to capacity assessment. To illustrate some of these challenges, this article presents a case of a patient with Alzheimer disease who refused a recommended operation and discusses the components of capacity, a useful mnemonic and tools, the variability of state laws, and the roles neurologists and psychiatrists play in the assessment of capacity.
医疗决策能力，即患者合理行使自主权的能力，是知情同意和知情拒绝的重要组成部分。因此，医疗决策能力的评估是医学伦理实践的基础。医疗决策能力并非全有或全无，而是存在一个连续体，应逐案进行评估。阿尔茨海默病和其他神经认知障碍会影响患者的医疗决策能力，可能给能力评估带来特殊挑战。为说明其中一些挑战，本文介绍了一例患有阿尔茨海默病的患者拒绝推荐手术的案例，并讨论了能力的组成部分、一个有用的记忆法和工具、州法律的差异以及神经科医生和精神科医生在能力评估中所起的作用。
