Capacity to give informed consent in patients with severe mental disorder in different treatment settings

Patients with severe psychiatric disorders, especially in forensic settings, encounter unique challenges in understanding and providing informed consent. These challenges stem from both individual cognitive or clinical impairments and the institutional context, such as coercive environments and complex legal-ethical frameworks. Our findings highlight the need for setting-sensitive communication strategies, legal safeguards, and increased awareness of advance care planning in forensic institutions. Future research should not only assess capacity, but also explore patients' willingness and opportunity to participate meaningfully in ethical and legal decisions about their care. The study was registered at ClinicalTrials.gov (NCT05939765).