Medical Decision-Making Capacity
Idil Yazgan
Background
- Capacity is a patient’s ability to make a specific medical decision at a specific point in time and can be assessed by any physician
- Capacity is fluid and may change with the patient’s mental status, medical state, and the specifics of the decision being presented. A person may have capacity to make one decision and not another
- Competency: “global decision-making capacity” or ability to make financial decisions, etc are legal determinations made by a judge
Evaluation
- Four components:
- Consistent choice: Patient must clearly indicate a consistent choice
- “Have you decided whether to follow the recommendation for the treatment?”
- “Can you tell me what your decision is?”
- Understand: Patient must grasp the fundamental meaning of the information communicated by the medical team.
- “Please tell me in your own words what you were told about:
- The problem with (1) your health now and (2) the recommended treatment.
- The risks/benefits of (3) treatment, (4) alternative treatments and (5) no treatment”.
- Appreciate: Patient must appreciate the medical condition and likely consequences of treatment options
- “What is treatment likely to do for you?”
- “What do you believe will happen if you’re not treated”
- “Why do you think this treatment was recommended?”
- Manipulate: Patient must rationally manipulate relevant information based on appropriate reasoning.
- “What makes the chosen option better than the alternative?”
- “How did you decide to accept or reject the recommended treatment?”
Management
- If the patient does not have medical decision-making capacity:
- Identify and remedy cause of impairment if possible (if decision is non-urgent).
- Identify surrogate decision maker. The hierarchy is as follows: 1) Durable Power-of-Attorney, 2) Spouse, 3) Adult children, 4) Parents, 5) Adult siblings, 6) Adult grandchildren, 7) Other adults with knowledge of pt.’s preferences/values.
- Documenting medical decision-making capacity:
- Use a dot phrase. Capacity that lists the four components and document your thought process citing evidence from your interview.
