Researchers from the Department of History, Philosophy and Ethics of Medicine, Centre for Health and Society Medical Faculty, at the Heinrich Heine University, Düsseldorf, Germany – EU-VIORMED P6 UDUS – (Heiner Fangerau, Chantal Marazia, and Vasilija Rolfes) provided a comprehensive training on MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to the EU-VIORMED partners (Wien, April 5-7, 2018). The training was based on the importance of assessing consent to treatment, which includes respect for patient autonomy, and a shared physician-patient decision-making model. This model takes into account both physician’s medical knowledge and skills, and health needs/preferences of the patient within the contextual demands of one’s own decision-making situation.
However, when suspicion exists about the ability of the patient to make a decision regarding medical treatment, the physician should assess the individual’s abilities to determine whether decisions can be accepted or whether substituted consent should be sought. For this reason, the MacCAT-T tool was developed by Grisso and Applebaum in the last decade of XXI century and then feasibility, reliability, and validity were tested (Grisso T, et al., 1997).
The tool represents a structured method for clinical practice and it was designed to elicit information on the patient’s ability in four areas: i) Understanding (Verstehen/ Comprensione), ii) Appreciation (Beurteilen/Giudizio), iii) Reasoning (Schlussfolgern/Ragionamento), and iv) Expressing a choice (Willen ausdrücken/Esprimere preferenze).
The semi-structured interview lasts about 20-30 min. The first step of the interview consist in a preparation phase in which the clinician gathers information that will be disclosed to the patient. Then, the clinician interviews the patient and carries out a rating task, based on both patient recorded responses and scoring guidelines proposed by Grisso and Appelbaum. Lastly, the interpretation phase with a comprehensive judgment on both scores and clinical data, including an examination of the patient’s mental status, psychiatric and neurologic conditions, and previously made decisions