To the Editor: Tielsch et al. (May 4 issue)1 are to be commended for their thorough and clinically relevant research on visual impairment in nursing home residents. But why did the authors employ a cognitive examination as a screening instrument to determine whether they would approach subjects or proxies to obtain informed consent? This practice reflects the mistaken notion that the cognitively impaired cannot grant informed consent. Decision-making capacity is at issue in informed consent, not competency.2,3 The assessment of decision-making capacity occurs during the first two parts of an informed-consent interview: disclosure and understanding. A categorical assessment of.
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