ABSTRACT
The right of capable persons to make decisions about their own care and safety is an integral presumption of legal and ethical practice in the United States. Rooted in respect for autonomy, the ceding of decisions to capable persons is articulated in the construct of informed consent. Landmark federal legislation (the Patient Self-Determination Act; Beauchamp & Childress, 1994) and many practitioner ethics codes, including the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (2002; “Ethics Code” in the following discussion) mandate that clinicians honor the individual’s right to autonomy. This “personal rule of the self … is free from both controlling interferences of others and from personal limitations that prevent meaningful choice, such as inadequate understanding” (Beauchamp & Childress, 1994, p. 121). How does the ethical practitioner proceed, however, when there is a question of inadequate understanding—when capacity itself is in question? Evaluating the integrity or impairment of a patient’s decision-making capacity will frequently be the task of the geriatric neuropsychologist.
