patient autonomy; biomedical ethics; decision-making capacity; advance directives; end of life
Hermann Helena, Trachsel Manuel, Elger Bernice S, Biller-Andorno Nikola (2016), Emotion and value in the evaluation of medical decision-making capacity: A narrative review of arguments., in
Frontiers in psychology, 7, 765-765.
Trachsel Manuel, Hermann Helena, Biller-Andorno Nikola (2015), Cognitive fluctuation as a challenge for the assessment of decision-making capacity in patients with different forms of dementia, in
American Journal of Alzheimer’s Disease and Other Dementias, 30(4), 360-363.
Hermann Helena, Trachsel Manuel, Biller-Andorno Nikola (2015), Einwilligungsfähigkeit: Inhärente Fähigkeit oder ethisches Urteil?, in
Ethik in der Medizin, 1.
Trachsel Manuel, Hürlimann Daniel, Hermann Helena, Biller-Andorno Nikola (2015), Umgang mit besonderen Herausforderungen bei der ärztlichen Beurteilung von Urteilsfähigkeit, in
Bioethica Forum, 8(2), 56-59.
Trachsel Manuel, Hürlimann Daniel (2015), Urteilsfähigkeit, Zurechnungsfähigkeit und Schuldfähigkeit, in
Swiss Medical Forum, 15(25), 604-606.
Hermann Helena, Trachsel Manuel, Biller-Andorno Nikola (2014), Physicians' personal values in determining medical decision-making capacity: A survey study, in
Journal of Medical Ethics, 41(9), 739-744.
Trachsel Manuel, Hermann Helena, Biller-Andorno Nikola (2014), Urteilsfähigkeit: Ethische Relevanz, konzeptuelle Herausforderung und ärztliche Beurteilung, in
Swiss Medical Forum, 14(11), 221-225.
Trachsel Manuel, Mitchell Christine, Biller-Andorno Nikola (2013), Decision-making incapacity at the end of life: Conceptual and ethical challenges, in
Bioethica Forum, 6(1), 26-30.
Trachsel Manuel, Mitchell Christine, Biller-Andorno Nikola (2013), Decision-making incapacity at the end of life: Conceptual and ethical challenges, in
Bioethica Forum, 6(1), 26-30.
Hermann Helena, Trachsel Manuel, Mitchell Christine, Biller-Andorno Nikola (2013), Medical decision-making capacity: Knowledge, attitudes, and assessment practices of physicians in Switzerland, in
Swiss Medical Weekly, 144, 1-7.
Hermann Helena, Trachsel Manuel, Biller-Andorno Nikola, Accounting for intuition in decision-making capacity: Rethinking the reasoning standard?, in
Philosophy, Psychiatry, & Psychology.
Trachsel Manuel, Mitchell Christine, Biller-Andorno Nikola, Advance directives between respect for patient autonomy and paternalism, in Lack Peter (ed.), Springer Science+Business Media, Dordrecht.
The end of life is often preceded by a phase of decision-making incapacity/incompetence. Being diagnosed as incompetent has important implications for a patient’s involvement in treatment decisions. Although the preferences expressed by the incompetent person will still be taken into consideration, patient preferences will then be mainly defined by an advance directive or a designated substitute decision-maker. If patient preferences - declared or presumed - are unknown, clinical decisions will be made according to what is assumed to the in the best interest of the patient. With respect for patient autonomy being regarded as an important value, the assessment of decision-making capacity plays a crucial role in medical law as well as in clinical practice. Finding appropriate standards for decision-making capacity, however, is a difficult ethical challenge: If standards are too low, patients are not protected from choices they are not in a condition to make, if standards are to high, the patient’s voice is unduly excluded from decisions that concern himself most. To date, there is no consensus on the concept of decision-making capacity nor on its operationalization (criteria, instruments, procedures). This issue is not only of theoretical interest, but does have an important policy dimension as well. For instance, various guidelines of the Swiss Academy of Medical Sciences (SAMS) use slightly different definitions and criteria of decision-making incapacity, which have evolved over the years. Finally, the issue is also of enormous practical relevance: Currently, we do not know how Swiss physicians evaluate decision-making capacity. Could it be that there is considerable heterogeneity, that a patient would be considered competent by one physician but incompetent for another? With patient rights becoming more and more recognized as an important element of modern medicine, transparent, well argued and clearly defined standards for the assessment of decision-making capacity are urgently needed. The proposed study aims to address these gaps through a critical analysis of the state of the art, based on a comprehensive review of the relevant literature and of existing assessment tools. The discussion of the findings is going to take place within an interdisciplinary working group that has been constituted, including ethicists, lawyers and psychiatrists/psychologists. In a second part, an empirical study will investigate how decision-making capacity is currently assessed by physicians in Switzerland, and to what degree they differ in their responses. Beyond internationally visible contributions to a controversial issue, the study expects to have an impact on policy-making in Switzerland.