Who Has the Ability to Consent?

Abstract

Objective: Previous studies have shown no consistent examinations for testing the ability of patients to consent in hospital emergency departments (EDs). The primary objective of this study was to compare providers' opinions with 3 capacity assessment tools to determine the ability of medical and psychiatric patients to consent in the ED.

Method: The study was conducted at a level 1 inner-city general hospital ED from June 2016 to October 2017. The study participants comprised a random sample of English-speaking patients aged ≥ 18 years who presented with any medical or psychiatric complaint. Each patient was administered 3 tools: the standard ED consent form, the Aid to Capacity Evaluation (ACE), and the Mini-Mental State Examination. The results of these assessments were then compared to the provider's opinion of the patient's ability to provide consent.

Results: A total of 283 patients participated in the study, and 84.4% were able to consent according to providers. There was a high level of consistency with the provider's assessment and the other assessment tools on the patient's ability to consent. Most patients, both medical and psychiatric, showed the ability to consent. However, this was less true for psychiatric patients with schizophrenia, as 32.6% (n = 14) were unable to consent.

Conclusions: The study revealed that the ACE capacity assessment was highly consistent with the providers' assessment for medical (88.3%) and psychiatric patients (80.3%), but not for psychiatric patients with schizophrenia. Using the ACE, patients with schizophrenia presenting to the ED were significantly less able to understand their illnesses (0.01) and treatments (0.04) and thus were less able to give consent.