used in either empirical research or clinical practice.
There are numerous reasons for the limited popularity of
the HCAT. Foremost among them is the “generic”
nature of the information presented and assessed, focus-
ing on the concept of informed consent and durable
power of attorney rather than a specific treatment deci-
sion. Clinical evaluations, and much of the emerging
research on informed consent and decision-making com-
petence, focus on a patient’s ability to formulate deci-
sions, not simply comprehension of the right to make
such treatment decisions. In fact, understanding of
informed consent may have little association with the
ability to make a rational choice among a set of compli-
cated options. Without tailoring the information dis-
closed to the patient’s particular medical conditions and
treatment options, HCAT scores have relatively little
bearing on the patient’s capacity to consent to a specific
intervention. These disadvantages are likely the reason
why the HCAT has been eclipsed by the MacArthur
instruments, which are designed to assess capacity to con-
sent to treatment and research: MacArthur Competence
Assessment Tool for Treatment (MacCAT–T) and
MacArthur Competence Assessment Tool for Clinical
Research (MacCAT–CR), respectively.
On the other hand, the HCAT has several advan-
tages for clinical research, including brevity, ease of
administration, and the generic nature of information
presented. Thus, this measure can be easily adminis-
tered in the context of a battery of assessment instru-
ments (in both research and clinical settings) and is
applicable to all patients, regardless of health state or
treatment needs. In clinical settings, the HCAT may,
with further research, become a useful screening mea-
sure that can quickly identify patients who need a more
thorough evaluation. Of course, further research is
clearly needed before the HCAT gains acceptance as a
useful clinical or research instrument. For example, a
comparison of the HCAT with more focused measures
of decision-making capacity, such as the MacArthur
instruments, would help clarify the relationship
between the general comprehension of informed con-
sent and the specific decision-making abilities that typ-
ically form the basis of such evaluations.Barry Rosenfeld and
Rebecca A. WeissSee also Capacity to Consent to Treatment; MacArthur
Competence Assessment Tool for Clinical Research
(MacCAT–CR); MacArthur Competence Assessment
Tool for Treatment (MacCAT–T)Further Readings
Barton, C. D., Mallik, H. S., Orr, W. B., & Janofsky, J. S.
(1996). Clinician’s judgment of capacity of nursing home
patients to give informed consent. Psychiatric Services,
47,956–959.
Janofsky, J. S., McCarthy, R. J., & Folstein, M. F. (1992).
The Hopkins Competency Assessment Test: A brief
method for evaluating patients’ capacity to give informed
consent. Hospital and Community Psychiatry, 43,
132–136.
Jones, B. N., Jaygram, G., Samuels, J., & Robinson, H.
(1998). Relating competency status to functional status at
discharge in patients with chronic mental illness. Journal
of the American Academy of Psychiatry & Law, 26,
49–55.
Sorger, B. M., Rosenfeld, B., Pessin, H., Timm, A. K., &
Cimino, J. (in press). Decision-making capacity in elderly,
terminally ill patients with cancer. Behavioral Sciences
and the Law.HYPNOSIS AND
EYEWITNESSMEMORY
The use of hypnosis to enhance the memory of a wit-
ness to a crime often results not only in some addi-
tional accurate recall of information about the event
but also in the incorporation of additional misinforma-
tion into the witness’s memory of the event and a gen-
eral increase in his or her confidence in the veracity of
recall. Research has shown that hypnosis increases the
amount of information that is recalled about an event.
This effect often occurs with other techniques also,
such as the cognitive interview. When techniques such
as hypnosis and the cognitive interview are used to
enhance a witness’s memory, the amount of new
information recalled turns out to be a mixture of accu-
rate and inaccurate information. Furthermore, once
accurate and inaccurate information get mixed into a
coherent narrative, the witness is typically not very
good at distinguishing those aspects of the story that
are true from those that are false. The additional infor-
mation will make the narrative the witness is trying to
construct more coherent, and his or her confidence in
it will increase. The witness’s memory has not been
refreshed. A more coherent narrative has been con-
structed that the witness feels is a more accurate rep-
resentation of the event he or she is being encouraged
to remember.360 ———Hypnosis and Eyewitness MemoryH-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 360