Mental Competency

Publication Title: 
The Journal of the American Academy of Psychiatry and the Law

The cognitive and behavioral changes that can be observed in the neurodegenerative terminal disease amyotrophic lateral sclerosis (ALS), once characterized as purely a motor neuron disease, have become increasingly recognized over the past century. Detecting cognitive deficits earlier and identifying continued changes at regular intervals can lead to improved care, proactive treatments, and earlier discussions about end-of-life wishes.

Author(s): 
Khin Khin, Eindra
Minor, Darlinda
Holloway, Amanda
Pelleg, Ayla
Publication Title: 
Dementia and Geriatric Cognitive Disorders

BACKGROUND: Mutations in the presenilin-1 gene (PSEN1) have been identified in autosomal dominant early-onset cases of Alzheimer's disease (AD). AIMS: To investigate different clinical phenotypes of siblings possessing the same heterozygous P264L mutation in the PSEN1 gene. METHODS: We evaluated clinical features, neuroimaging results, and neuropsychological examinations. The PSEN1 gene and other dementia-related gene mutations were screened.

Author(s): 
Ishizuka, Takanori
Nakamura, Masayuki
Ichiba, Mio
Fujita, Seigo
Takeuchi, Kouzo
Fujimoto, Toshiro
Sano, Akira
Publication Title: 
Medical Care

Voluntary informed consent is a hard problem--one that inheres in the domain of research. The standard definition requires four criteria for consent to be morally valid: disclosure, understanding, voluntariness, and competence. These standards apply across the continuum of activities that comprise research. This paper concentrates on consent for the desperately sick, for whom enrollment in a research trial represents the last best hope of rescue. The literature indicates that many of these subjects enroll in research on the basis of feelings of hope or trust.

Author(s): 
Bosk, Charles L.
Publication Title: 
Medical Care

Voluntary informed consent is a hard problem--one that inheres in the domain of research. The standard definition requires four criteria for consent to be morally valid: disclosure, understanding, voluntariness, and competence. These standards apply across the continuum of activities that comprise research. This paper concentrates on consent for the desperately sick, for whom enrollment in a research trial represents the last best hope of rescue. The literature indicates that many of these subjects enroll in research on the basis of feelings of hope or trust.

Author(s): 
Bosk, Charles L.
Publication Title: 
Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing

PURPOSE: To describe issues and dilemmas related to nonparticipation, attrition, and needs for assistance in research with vulnerable home hospice participants. DESIGN AND METHODS: Retrospective analysis, with descriptive statistics of the frequency of issues and dilemmas that occurred in a research study with a vulnerable population.

Author(s): 
Dobratz, Marjorie C.
Publication Title: 
Investigational New Drugs

In the early drug development process for cancer therapy, several ethical dilemmas result from the use of cancer patients with advanced disease as the subjects of research in clinical trials studying agents of unknown toxicity and/or efficacy. Although several accepted ethical principles guide the behavior of involved physicians and investigators, many of these principles are allowed to be violated in order to achieve the overall goal of clinical research in improving medical care for future patients.

Author(s): 
Daugherty, C. K.
Publication Title: 
Boston College Law Review. Boston College. Law School

Organ transplants may offer the best hope of long term survival for individuals afflicted with certain cancers or other debilitating diseases. The hope that a transplant may inspire in an organ recipient should not, however, be the determinative factor when the proposed source of the organ is incompetent. Competent adults are not compelled to act altruistically by undergoing a surgical invasion for the benefit of third parties. Children and mentally incompetent adults should likewise be protected from such compelled altruism.

Author(s): 
Cheyette, C.
Publication Title: 
Journal of the American Geriatrics Society

OBJECTIVES: To examine the capacity, competency, and reasons for enrolling of patients with Alzheimer's disease (AD) and of their caregivers in an early phase AD clinical trial. DESIGN: Interviews were conducted with patients with AD, nondemented older persons, and caregivers. SETTING: Participants' homes. PARTICIPANTS: Fifteen patients with mild to moderate AD, 15 age- and education-matched nondemented older persons, and 15 patient caregivers.

Author(s): 
Karlawish, Jason H. T.
Casarett, David J.
James, Bryan D.
Publication Title: 
Journal of Medical Ethics

BACKGROUND: Informed consent is regarded as a contract between autonomous and equal parties and requires the elements of information disclosure, understanding, voluntariness and consent. The validity of informed consent for critically ill patients has been questioned. Little is known about how these patients experience the process of consent. OBJECTIVE: The aim of this study was to explore critically ill patients' experience with the principle of informed consent in a clinical trial and their ability to give valid informed consent.

Author(s): 
Mangset, M.
F¯rde, R.
Nessa, J.
Berge, E.
Wyller, T. Bruun
Publication Title: 
The American Journal of Psychiatry

OBJECTIVE: Research that seeks to enroll noncompetent patients with Alzheimer's disease without presenting any potential benefit to participants is the source of substantial ethical controversy. The authors used hypothetical Alzheimer's disease studies that included either a blood draw or a blood draw and lumbar puncture to explore older persons' attitudes on this question. METHOD: Face-to-face interviews were conducted with 538 persons age 65 and older.

Author(s): 
Karlawish, Jason
Rubright, Jonathan
Casarett, David
Cary, Mark
Ten Have, Thomas
Sankar, Pamela

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