JRSM >
Volume 96, Number 5 >
Pp. 257
Département de médecine, Université de Montréal, Porte S-757, C.P. 6128, Sucoursale Centre-Ville, Montréal, Québec H3C 3J7, Canada
E-mail: stephane.ahern{at}umontreal.ca
Dr Jackson and Dr Warner (December 2002 JRSM1) point to large gaps in doctors' knowledge of consent and capacity. Two aspects of their project should, however, be questioned. First, the concept of a patient in whom capacity issues may be relevant is problematic. As White has pointed out,2 even if legal and ethical standards support a positive assumption regarding the decision-making competence of the patient, a physician, when seeking approval of a treatment plan, should always make sure that the patient possesses adequate decision-making abilities. Second, whatever the legal position, physicians and other healthcare professionals remain the ones who are responsible for the first-hand evaluation. When a court must decide on a decision-making-capacity issue, the judge depends almost exclusively on the evaluation made by the physician. Research must then look to the process of decision-making capacity of the patient as affected by special diseases. Marson et al. did this in Alzheimer's disease.3, 4, 5 Other researchers, myself included, are turning their attention to the ethico-clinical judgment of the physician. Doctors evaluate, almost daily, decision capacity issues. Taking into account the work of Schön, we hypothesize that physicians have expert knowledge of these matters, even if it is unconscious.
Issues on ability to consent represent a challenge to every physician on a clinical ward, since all healthcare professionals are engaged in what should be an informed consent procedure with their patients.
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