Capacity to consent to treatment in adolescents with anorexia nervosa
Bibliographic record
Abstract
Overall, healthy adolescents demonstrated decision-making skills that were superior to adolescents with anorexia nervosa, regardless of the context of the decision (e.g., medical versus psychiatric). Furthermore, adolescents with anorexia nervosa were significantly less able to reason about treatment for their own illness than they were for hypothetical illnesses. These findings are discussed in terms of their clinical implications. Over the last three decades, the rights of children and adolescents to exercise autonomy in the consent process have expanded. In Ontario, the Health Care Consent Act stipulates that everyone, regardless of age or diagnosis, should be considered capable to make his or her own treatment decisions. Clinical encounters with patients with anorexia nervosa have brought forth challenging ethical and legal issues surrounding the capacity of these patients to make their own treatment decisions, owing largely to the cognitive distortions that are part of the diagnostic criteria for the disorder, as well as serious and potentially life-threatening complications of treatment refusal. The current study compared the ability of adolescents with and without anorexia nervosa to make treatment decisions about hypothetical illnesses, presented in the form of vignettes. Adolescents with anorexia nervosa were also assessed with regards to their decision-making skills for their own illness. In addition, the relationship between cognitive and maturity of judgment variables and the ability to make a treatment decision was examined. The results suggest that adolescents who are hospitalized for anorexia nervosa appear to be less mature than healthy adolescents with regards to responsibility, a component of maturity of judgment. The adolescents with anorexia nervosa were no different from healthy adolescents on the remaining cognitive or maturity of judgment variables.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".