Anaethetists' knowledge regarding decision-making capacity: a biothical enquiry

Abstract

In healthcare, decision-making capacity (DMC) refers to a patient’s ability to make treatment related decisions. It is a prerequisite of informed consent and has moral and legal significance. The majority of capacity assessments are performed by doctors using clinical judgement. Studies have shown that doctors fail to recognise a significant proportion of patients who lack DMC. In order to improve reliability, formal tests of DMC have been developed but these have several shortcomings. Mixed methods were used in this study which investigated anaesthetists’ level of knowledge regarding decision-making capacity. The normative component emphasised the importance of doctors’ knowledge in DMC assessment. Medical education ought to be reformed in order to improve doctors’ knowledge. Formal tools for DMC assessment ought to supplement doctors’ knowledge. The empirical component of the study was a prospective, cross-sectional descriptive study conducted in the Anaesthetic Department at the University of the Witwatersrand. Of the 89 anaesthetists who completed the survey 3 (3%) had extracurricular education about the assessment of DMC and 11(12%) were aware of a standardised test that could be used for DMC assessment. Fifty-seven percent (57%) indicated that they had never used an objective test to assess DMC. The survey identified that there were several areas where significant knowledge deficits exist. These deficits pertained to decisional relativity, the conflation of cognition and capacity, the use of the Mini-Mental State Examination (MMSE) for capacity assessments and consent in emergency situations. These deficits in knowledge may affect anaesthetists informed consent process and have the potential for ethical and medicolegal violations.