Biller-Andorno Trachsel Hermann Elger

Fakultäten » Medizinische Fakultät » Biomedizinische Ethik und Medizingeschichte, Institut für » Prof. Dr. Nikola Biller-Andorno » Biller-Andorno Trachsel Hermann Elger

Completed research project

Title / Titel Decision-making capacity and its assessment
PDF Abstract (PDF, 14 KB)
Summary / Zusammenfassung Decision-making capacity has important implications for a patient’s involvement in treatment decisions. Although the preferences expressed by the decision-making incapable person will still be taken into consideration, patient preferences will then be mainly defined by an advance directive or a designated substitute decision-maker. If patient preferences – declared or presumed – are unknown, clinical decisions will be made according to what is assumed to be in the best interest of the patient.

With respect for patient autonomy being regarded as an important value, the assessment of decision-making capacity (DMC) plays a crucial role in medical law as well as in clinical practice. Finding appropriate standards for DMC, however, is a difficult ethical challenge: If standards are too low, patients are not protected from choices they are not in a condition to make, if standards are to high, the patient’s voice is unduly excluded from decisions that concern himself most.

To date, there is no consensus on the concept of DMC nor on its operationalization (criteria, instruments, procedures). This issue is not only of theoretical interest, but does have an important policy dimension as well. For instance, various guidelines of the Swiss Academy of Medical Sciences (SAMS) use slightly different definitions and criteria of DMI, which have evolved over the years. Finally, the issue is also of enormous practical relevance: Currently, we do not know how Swiss physicians evaluate DMC. Could it be that there is considerable heterogeneity, that a patient would be considered competent by one physician but incompetent for another? With patient rights becoming more and more recognized as an important element of modern medicine, transparent, well argued and clearly defined standards for the assessment of DMC are urgently needed.

The proposed study aims to address these gaps through a critical analysis of the state of the art, based on a comprehensive review of the relevant literature and of existing assessment tools. The discussion of the findings is going to take place within an multi-disciplinary working group that has been constituted, including physicians, ethicists, lawyers and psychiatrists/psychologists. In a second part, an empirical study will investigate how decision-making capacity is currently assessed by physicians in Switzerland, and to what degree they differ in their responses. Beyond internationally visible contributions to a controversial issue, the study expects to have an impact on policy-making in Switzerland.
Publications / Publikationen Hermann, H., Trachsel, M., & Biller-Andorno, N. (accepted). Accounting for intuition in decision-making capacity: Rethinking the reasoning standard? Philosophy, Psychiatry & Psychology.

Hermann, H., Trachsel, M., & Biller-Andorno, N. (2015). Einwilligungsfähigkeit: Inhärente Fähigkeit oder ethisches Urteil? [Decision-making capacity: Intrinsic ability or ethical judgment?] Ethik in der Medizin. Online first

Hürlimann, D., & Trachsel, M. (2015). Urteilsfähigkeit, Zurechnungsfähigkeit und Schuldfähigkeit. Swiss Medical Forum, 15(25), 604-606.

Trachsel, M., Hürlimann, D., Hermann, H., & Biller-Andorno, N. (2015). Umgang mit besonderen Herausforderungen bei der ärztlichen Beurteilung von Urteilsfähigkeit [Handling of particular challenges in the medical assessment of decision-making capacity]. Bioethica Forum. Swiss Journal of Biomedical Ethics, 8(2), 20-24.

Hermann, H., Trachsel, M., & Biller-Andorno, N. (2015). Physicians’ personal values in determining medical decision-making capacity: A survey study. Journal of Medical Ethics. Online first.

Hermann, H., Trachsel, M., Mitchell, C, & Biller-Andorno, N. (2014). Medical decision-making capacity: knowledge, attitudes, and assessment practices of physicians in Switzerland. Swiss Medical Weekly, 144:w14039.

Trachsel, M., Hermann, H., & Biller-Andorno, N. (2014). Cognitive fluctuations as a challenge for the assessment of decision-making capacity in patients with dementia. American Journal of Alzheimer’s Disease and Other Dementias, 30(4), 360-363.

Trachsel, M., Hermann, H., & Biller-Andorno, N. (2014). Urteilsfähigkeit: Ethische Relevanz, konzeptuelle Herausforderung und ärztliche Beurteilung [Decision-making capacity: Ethical relevance, conceptual challenge, and medical assessment]. Swiss Medical Forum, 14(11), 221-225.

Trachsel, M., Mitchell, C., & Biller-Andorno, N. (2013). Decision-making incapacity at the end of life: conceptual and ethical challenges. Bioethica Forum, 6(01), 26-30.

Trachsel, M., Mitchell, C., & Biller-Andorno, N. (2013). Advance directives in the area of conflict between individualism and paternalism. In P. Lack, N. Biller-Andorno, & S. Brauer (Hrsg.). Advance directives, International Library of Ethics, Law, and the New Medicine 54. Dordrecht: Springer Science+Business Media.

Keywords / Suchbegriffe decision-making capacity, competence, ethics, end of life, autonomy, self-determination, beneficence, ethics, medicine, psychiatry, mental disorder, law
Project leadership and contacts /
Projektleitung und Kontakte
Prof. Dr. med. Dr. phil. Nikola Biller-Andorno (Project Leader)
Dr. phil. B. Med. Manuel Trachsel (Project Leader)
Dr. sc. med. Helena Hermann (Project Leader)
Prof. Dr. Bernice Elger (Project Leader)
Other links to external web pages
Funding source(s) /
Unterstützt durch
SNF (Programm NFP)
NRP 67 - "End of life"
Duration of Project / Projektdauer May 2012 to Feb 2017