COMPETENCE TO CONSENT TO TREATMENT AND INFORMED CONSENT IN NEUROBEHAVIORAL REHABILITATION

Rehabilitation programs for the treatment of brain-injury patients in general, and behaviorally disordered brain-injury patients in particular, have experienced tremendous growth over the past decade: Interventions similar to those used with psychiatric patients have been adopted for the latter population, yet it is not clear that the rehabilitation community has adequately addressed issues of competency to consent to treatment or informed consent with these populations. Two hundred brain-injury facilities were surveyed regarding these issues. Results indicated a very common use of restrictive and pharmacologic interventions, often for extended periods, with quite frequently inadequate attention to assessing competency and/or obtaining proxy-informed consent. Legal and ethical implications are discussed, and suggestions for neuropsychologists and rehabilitation facilities are offered.