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The capacity of people with a 'mental disability' to make a health care decision
Wong, J.G., Clare, I.C.H., Holland, A.J., WATSON, P.C. & Gunn, M.
Psychological Medicine, 30(2), 295-306
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BACKGROUND: Based on the developing clinical and legal literature, and using the framework adopted in draft legislation, capacity to make a valid decision about a clinically required blood test was investigated in three groups of people with a ëmental disabilityí (i.e. mental illness (chronic schizophrenia), ëlearning disabilityí (ëmental retardationí, or intellectual or developmental disability), or, dementia) and a fourth, comparison group. METHODS: The three ëmental disabilityí groups (N = 20 in the ëlearning disabilityí group, N = 21 in each of the other two groups) were recruited through the relevant local clinical services; and through a phlebotomy clinic for the ëgeneral populationí comparison group (N = 20). The decision-making task was progressively simplified by presenting the relevant information as separate elements and modifying the assessment of capacity so that responding became gradually less dependent on expressive verbal ability. RESULTS:Compared with the ëgeneral populationí group, capacity to make the particular decision was significantly more impaired in the ëlearning disabilityí and ëdementiaí groups. Importantly, however, it was not more impaired among the ëmental illnessí group. All the groups benefited as the decision-making task was simplified, but at different stages. In each of the ëmental disabilityí groups, one participant benefited only when responding did not require any expensive verbal ability. CONCLUSIONS: Consistent with current views, capacity reflected an interaction between the decision-maker and the demands of the decision-making task. The findings have implications for the way in which decisions about health care interventions are sought from people with a ëmental disabilityí. The methodology may be extended to assess capacity to make other legally-significant decisions.