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Schizophrenia Bulletin Advance Access originally published online on September 21, 2005
Schizophrenia Bulletin 2006 32(1):22-25; doi:10.1093/schbul/sbi063
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© The Author 2005. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Decisional Capacity of Patients With Schizophrenia to Consent to Research: Taking Stock

Paul S Appelbaum1,2–4,
2 Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA 01655
3 as of January 1, 2006, Department of Psychiatry, College of Physicians and Surgeons, Columbia University
4 as of January 1, 2006, Division of Psychiatry, Law, and Ethics, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032

1To whom correspondence should be addressed; phone: 508-856-3066, fax: 508-856-2725, e-mail: appelbap{at}ummhc.org.

With the growth in recent years of studies of decisional capacity for research among people with schizophrenia, this is an opportune time to ask three questions: What have we learned from these studies? What remains to be learned? And what normative issues still need to be resolved? Among the things learned are that patients with schizophrenia, as a group, have lower scores on measures of decisional capacity than normals, but higher performance than patients with dementia. However, performance is highly variable within the group, correlates most strongly with neuropsychological impairment, and seems susceptible in many patients to successful remediation. The issues that remain in need of exploration include the development of a brief screening instrument for decisional capacity that can be used routinely, and the identification of those patients most likely to benefit from more intensive informational procedures. Finally, among the normative issues still in need of resolution are the degree of capacity needed to consent to research participation, how to deal with fluctuating capacity during research projects, and the legitimate extent of surrogate consent for participation of incompetent patients in research.

Keywords: decisional capacity / informed consent / schizophrenia / research


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