Capacity Assessment
Capacity: person’s ability to ...

Capacity Assessment

Capacity: person’s ability to make an informed decision about a specific question. It can change over time.

Competence: legal designation made by judge. Determines a person’s ability to make decisions in multiple areas of life.

Any physician can make a determination of capacity. Psychiatry should be consulted only for capacity assessment in complex cases, such as when neuropsychiatric illness may be impairing decision-making or when the pt, family, and medical team disagree on decisionmaking. Before consulting psychiatry, explain risks/benefits to patient and know patient’s expressed decision. If consult required, have risks & benefits of each intervention available to consultant.

The strictness of the capacity test varies as the risk/benefit ratio of a decision changes: the more favorable the risk/benefit ratio, the lower the standard for capacity to consent and higher the standard to refuse, and vice versa.

Criteria for Determining Capacity (all must be met for patient to have capacity):

 • Communicate a clear and stable choice - Ask patient to indicate a choice. No expression is a presumption of incapacity. Frequent reversals of choice may indicate lack of capacity.

 • Understand relevant information - Ask patient to describe his/her understanding of the information given by the physician (diagnosis, proposed intervention, purpose of intervention, risks/benefits, risks/benefits of alternatives including no intervention).

 • Appreciate the situation and its consequences - Ask patient to describe views of diagnosis, interventions, and likely outcomes. Is patient aware of her illness? Its seriousness? Consequences?

 • Be able to manipulate information provided in a rational fashion - Ask patient to compare treatment options, consequences, and reasons for choice. Does the patient weigh the risks and benefits logically? 

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