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Under ideal circumstances, we would ask consent only from people with fully intact cognition and ability to understand all of the relevant issues.
In reality, many of our patients are unable to fully understand certain aspects of a given decision, even when their cognition is intact.
Yet these people are able to make informed choices about complex issues.
Furthermore, patients with altered thought processes can make valid informed decisions.
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- Try to determine if your patient is capable of understanding his/her current medical situation, even though some possibly unrelated cognitive disfunction may be present.
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One example is a schizophrenic patient who is not in an acute psychotic episode, and whose hallucinations and delusions do not influence the decision at hand.
Other examples are patients with Down's syndrome and mild mental retardation, or patients with mild dementia, who are able to make informed decision because they can appreciate the situation, the choice at hand, and the consequences.
Do not assume that the presence of thought disorders or mild cognitive impairment preclude informed decision-making.
It is always prudent to review decisions made by such patients with their families.
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- Remember that mild cognitive impairment does not necessarily prevent patients from making reasonable, educated decisions about the condition.
- It is wise to review these decisions with a patient's family.
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