Should patients with profound communication impairments be permitted to make healthcare decisions?

Doctors are morally required to respect the autonomy of patients. Yet, in some cases, a patient's decision-making capacity may be unknown. Attempts to evaluate decision-making capacity may be hindered by a patient's condition, including the inability to verbally communicate. This can put patients at risk for loss of autonomy.

Andrew Peterson and his colleagues at The Rotman Institute of Philosophy, London Health Sciences Centre, and The University of Windsor have developed the first general strategy for assessing decision-making capacity under such conditions, published this week in Cambridge Quarterly in Healthcare Ethics. Their article discusses this problem in the context of a particular patient, Ms. M, who had severe communication impairments resulting from a brain injury.