Assessing Decision-Making Capacity after Brain Injury: A Phenomenological Approach

The assessment of decision-making capacity in patients with brain injuries presents a range of clinical and legal challenges. Existing guidance on the conduct of such assessments is often generic; guidance specific to patients with brain injury is sparse and coarse-grained. We report on an interview-based study of decision-making capacity in patients suffering from acquired brain injury and organic personality disorder. We identify challenges associated with the assessment of DMC in this patient population, review three bodies of relevant research from cognitive neuropsychology and neurophysiology, and draw on phenomenological analysis to identify three distinct abilities that play a role in decision-making, but which can be compromised in patients with organic personality disorder. We address the challenge of translating clinical findings into legally attestable results.