Informed consent procedures with cognitively impaired patients: A review of ethics and best practices.


AIMS:The objectives of this article are to discuss ethical issues of informed consent in cognitively impaired patients and review considerations for capacity determination. We will also discuss how to evaluate capacity, determine competence, and obtain informed consent when a patient is deemed incompetent. This review emphasizes how to carry out informed consent procedures when capacity is questionable and discusses measures supported for use when determining cognitively impaired patients' ability to consent. METHODS:Information was gathered from medical and psychological codes of ethics, peer-reviewed journals, published guidelines from health-care organizations (e.g., American Medical Association), and scholarly books. Google Scholar and PsycINFO were searched for articles related to 'informed consent' and 'cognitive impairment' published in English between 1975 and 2014. Relevant sources referenced in retrieved publications were subsequently searched and reviewed. RESULTS:We selected 49 sources generated by our search. Sources were included in our review if they presented information related to at least one of our focus areas. These areas included: review of informed consent ethics and procedures, review of cognitive impairment evaluations, recommendations for measuring cognitive capacity, and alternative forms of informed consent. CONCLUSIONS:Patients' cognitive impairments can hinder the ability of patients to understand treatment options. Evaluating the capacity of patients with cognitive impairment to understand treatment options is vital for valid informed consent and should be guided by best practices. Thus, proper identification of patients with questionable capacity, capacity evaluation, and determination of competence, as well as reliance upon appropriate alternative consent procedures, are paramount.


Fields LM,Calvert JD




Has Abstract


2015-08-01 00:00:00












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    authors: Ishibashi K,Tanaka K,Nakabayashi T,Nakamura M,Uchiyama M,Okawa M

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    更新日期:2019-09-01 00:00:00

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    authors: Lin SK,Huang MC,Lin HC,Pan CH

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    abstract::Interleukin-1 (IL1) is an inflammatory cytokine and exerts neurodegenerative effects in the brain. Several studies have indicated that IL1 is likely to be involved in the pathogenesis of schizophrenia. Recent genetic studies have revealed that the IL1 gene complex (IL,1 alpha, IL1, beta and IL1 receptor antagonist) wa...

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    authors: Watanabe Y,Nunokawa A,Kaneko N,Muratake T,Koizumi M,Someya T

    更新日期:2007-08-01 00:00:00

  • DNA methylation of membrane-bound catechol-O-methyltransferase in Malaysian schizophrenia patients.

    abstract:AIM:This study examined catechol-O-methyltransferase (COMT) DNA methylation in the peripheral blood of schizophrenia patients and also in healthy controls to investigate its potential use as a peripheral biomarker of schizophrenia and its relations with the clinical variables of schizophrenia patients. METHODS:We exam...

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    authors: Nour El Huda AR,Norsidah KZ,Nabil Fikri MR,Hanisah MN,Kartini A,Norlelawati AT

    更新日期:2018-04-01 00:00:00

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    abstract::We investigated the mechanism of abnormal P300 findings in the patients with severe sleep apnea syndrome (SAS). Compared with controls, SAS patients showed significantly longer latency of P300. Not the mean sleep latency in multiple sleep latency test but the percentage of total periods in which percentage desaturatio...

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    authors: Inoue Y,Nanba K,Kojima K,Mitani H,Arai AH

    更新日期:2001-06-01 00:00:00

  • Four cases of venous thromboembolism associated with olanzapine.

    abstract:AIMS:Psychiatric disorders and treatment with conventional antipsychotic medications have been associated with venous thromboembolism, but only a few data on recent antipsychotics such as olanzapine are available. METHODS:We describe four subjects treated with olanzapine who developed venous thromboembolism, and were ...

    journal_title:Psychiatry and clinical neurosciences

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    authors: Maly R,Masopust J,Hosak L,Urban A

    更新日期:2009-02-01 00:00:00

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    authors: Jibiki I

    更新日期:1995-06-01 00:00:00

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    authors: Egawa J,Nunokawa A,Shibuya M,Watanabe Y,Kaneko N,Igeta H,Someya T

    更新日期:2013-05-01 00:00:00

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    authors: Ikejima C,Ikeda M,Hashimoto M,Ogawa Y,Tanimukai S,Kashibayashi T,Miyanaga K,Yonemura K,Kakuma T,Murotani K,Asada T

    更新日期:2014-03-01 00:00:00

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    authors: Nakamura K,Kitanishi K,Miyake Y,Hashimoto K,Kubota M

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    authors: Morioka C,Nameta K,Komatsu Y,Tsujio T,Kondo H

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    authors: Fukuda M,Hata A,Niwa S,Hiramatsu K,Yokokoji M,Hayashida S,Itoh K,Nakagome K,Iwanami A

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    pub_type: 杂志文章


    authors: Kobayashi R

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    更新日期:2014-06-01 00:00:00

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    pub_type: 杂志文章


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    pub_type: 杂志文章


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    更新日期:2004-10-01 00:00:00