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Do Clinicians Follow a Risk-Sensitive Model of Capacity-Determination? An Experimental Video Survey

Received July 12, 2005; revised October 17, 2005; accepted October 20, 2005. From the Dept. of Psychiatry, the Bioethics Program, and the Center for Behavioral and Decision Sciences in Medicine, Univ. of Michigan; the Dept. of Psychiatry, Univ. of Rochester; and the Dept. of Psychiatry, Columbia Univ. Medical School. Send correspondence and reprint requests to Dr. Kim, 300 North Ingalls St., 7C27, Ann Arbor, MI 48109-0429. e-mail: scottkim{at}umich.edu

The authors asked whether clinicians use a risk-sensitive model for decisional-capacity determinations; that is, whether a higher degree of capacity was required in higher-risk situations. The respondents were randomly assigned to view a videotaped "capacity" interview of a medication-randomized clinical trial scenario (N=52) or a neurosurgical clinical trial scenario (N=47). A significant scenario effect was mediated by the respondents’ perception of scenario-specific risk. Respondents showed considerable disagreement within each scenario that was not explained by clinician-specific factors. Thus, clinicians, in fact, use the normative risk-sensitive model for capacity, but there remains considerable unexplained variability in their judgments.

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