SLIDE 1
An Outline on Capacity
Presented by: Emily Levinson, University of Missouri 4th Year Medical Student
- Capacity is a clinical term and may be assessed by medical professionals.
- Decisional capacity is task specific and can fluctuate over time.
- Competence is a legal term and can be decided only by a judge.
- Guardian makes all decisions in any areas of incompetency
- Can be competent in some areas and incompetent in others (ex- make contracts, make wills, be
a witness or stand trial in court, make medical decisions, etc.)
- In order for a patient to have decisional capacity, he or she must be able to:
- Understand the relevant information regarding treatment (purpose, risks, benefits).
- Appreciate the appropriate weight and impact of the decision.
- Logically manipulate the information to make a decision.
- Note: Severe depression or hopelessness will make it difficult to interpret decisionality
- Communicate a choice or preference.
- Consistency- Do they change their mind? Is the decision consistent with values?
- Decision dependent: Criteria for determining capacity may be more stringent if the consequences of a
patient's decision are very serious.
- Decision capacity is task specific and time specific
- Task specific:
- Some decisions are more complex than others, requiring a higher level od decision-
making capacity against the objective risk and benefits of the patients
- Ex: A moderately demented patient may be able to make some decisions (e.g.
antibiotics for pneumonia) but not others (e.g. chemotherapty for metastatic lung cancer).
- Higher level of certainty in decisional capacity when decision poses great harm
- Example: Decision to do palliative radiation vs. decision to start
chemotherapy
- Time specific
- When encephalopathic, a patient may not be decisional; after treatment decisionality
may be regained. 10 Myths about Capacity:
- 1. Decision making capacity = competency
- 2. Against Medical advice = lack of decision making capacity
- 3. There’s no need to assess decision-making capacity unless a patient goes against medical advice.
- 4. Decision-making capacity is all or nothing.
- 5. Cognitive impairment = no decision- making capacity.
- 6. Lack of decision-making capacity is permanent.
- 7. All patients with certain psychiatric disorders lack decision-making capacity.
- 8. Only psychiatrists and psychologists can assess decision-making capacity
- 9. All institutionalized patients lack decision making capacity.
- 10. Patients who have not been given relevant information about their condition can lack decision-making