Determining Decision-Making Capacity in Individuals with Severe Communication Impairments After Stroke: The Role of Augmentative-Alternative Communication (AAC)

Abstract

A speech-language pathologist and occupational therapist specializing in assistive technology were requested to assess an individual 2 years post hemorrhagic lesion in his brainstem, with significant medial issues, limited expressive communication skills, and motor function. The family wanted to determine if he had an adequate quality of life and whether he could provide informed consent if asked about the continuation or withdrawal of medical treatment to maintain his life. Issues discussed include determining competency for decision making regarding quality of life with individuals who cannot speak, write, or type, and what role the speech-language pathologist and occupational therapist can play in attempting to find these answers. A means of communication for this individual was identified that allowed him to provide information related to his preferences including physical state. Use of appropriate augmentative-alternative communication equipment and techniques became the means to further explore more complex medical decisions for this individual.

Keywords:

• augmentative communication
• decision-making capacity
• quality of life
• withdrawal of life-sustaining treatment