The Assessment of Decisional Capacity: Gender Differences, Corresponding Medical and Psychiatric Illness, and Their Impact on Decisional Capacity

Abstract

To date, gender differences and decisional capacity have not been studied. Altogether, decisional capacity assessments were required twice as often for male than for female patients. While female patients more commonly had endocrine disorders, male patients more commonly had neurological disorders, which contributed to decisional capacity impairment. Psychiatrically, mood disorders were more common in women and substance use disorders in men. Regarding decisional capacity tasks, men more frequently requested to sign out against medical advice. Overall, the ability to make appropriate health care decisions did not vary between genders. Although more decisional capacity assessments were requested for male patients, the degree to which decisional capacity existed did not vary between genders. Male patients more often displayed substance use and neurological disorders and more frequently requested to sign out against medical advice. Cognitive disorders caused more impairment for men than for women.

Keywords:

• decisional capacity
• gender
• medical illness
• psychiatric illness

ACKNOWLEDGEMENTS

The authors would like to thank the residents of the Department of Psychiatry at the New York University School of Medicine and attending physicians of the Consultation-Liaison Psychiatry service at Bellevue Hospital Center in New York who contributed to this chart review with their assessments of decisional capacity. No conflicts of interest were involved in this research.