Medical Decision-Making Capacity¶
Chelsea Sprick, Neil Phillips, Jonathan Smith
Background¶
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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
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Competency: “global decision-making capacity,” a legal determination made by a judge
Four key components to assess medical decision-making capacity¶
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Choice: patient must clearly indicate a consistent choice
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“Have you decided whether to follow the recommendation for the treatment?”
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“Can you tell me what your decision is?”
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Understand: Patient must grasp the fundamental meaning of the > information communicated by the medical team
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“Please tell me in your own words what you were told about:
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The problem with (1) your health now and (2) the recommended treatment
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The risks/benefits of (3) treatment, (4) alternative treatments and (5) no treatment”
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Appreciate: the medical condition and likely consequences of > treatment options
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“What do you believe is wrong with your health now?”
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“What is treatment likely to do for you?”
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“What do you believe will happen if you’re not treated”
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“Why do you think this treatment was recommended?”
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Reason: patient must rationally manipulate relevant information
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“What makes the chosen option better than the alternative?”
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“How did you decide to accept or reject the recommended treatment?”
If the patient does not have medical decision-making capacity:
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Identify and remedy cause of impairment if possible (if decision is non-urgent)
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Identify surrogate decision maker
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