Medical Patients’ Treatment Decision Making Capacity: A Report from a General Hospital in Greece

Nikolaos Bilanakis 1, Aikaterini Vratsista 1, Eleni Athanasiou 2, Dimitris Niakas 3, Vaios Peritogiannis 4, *
1 Psychiatric Department of General Hospital of Arta, Arta, Greece
2 Department of Internal Medicine, General Hospital of Arta, Arta, Greece
3 Hellenic Open University, Athens, Greece
4 Psychiatrist, Private Sector, Ioannina, Greece

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© Bilanakis et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Private Sector Psychiatrist; Moulaimidou Str 1, Ioannina, 45444, Greece; Tel/Fax: 0030265121227; E-mail:


This study aimed to assess the decision-making capacity for treatment of patients hospitalized in an internal medicine ward of a General Hospital in Greece, and to examine the views of treating physicians regarding patients’ capacity. All consecutive admissions to an internal medicine ward within a month were evaluated. A total of 134 patients were approached and 78 patients were interviewed with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and the Mini Mental State Examination (MMSE) questionnaire. Sixty-eight out of 134 patients (50.7%) were incompetent to decide upon their treatment. The majority of them (n=56, 41.8%) were obviously incapable because they were unconscious, or had such marked impairment that they could not give their own names, and the rest (n=12, 8.9%) were rated as incompetent according to their performance in the MacCAT-T. Neurological disorders, old age and altered cognitive function according to MMSE were negatively correlated with decision making capacity. Physicians sometimes failed to recognize patients’ incapacity. Rates of decision-making incapacity for treatment in medical inpatients are high, and incapacity may go unrecognized by treating physicians. Combined patient evaluation with the use of the MacCAT-T and MMSE, could be useful for the determination of incapable patients.

Keywords: Decision-making capacity for treatment, informed consent, MacCAT-T, medical patients..