Decision Making Capacity

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Contents 1 More Specific Terms 2 Introduction 3 Clinical-significance 4 Notes 5 More General Terms 6 Additional Terms 7 References

More Specific Terms

• assessment of decisional capacity

Introduction

• Ability to adequately participate in medical decisions.

Clinical-significance

• decisional capacity of the patient to make informed decisions
• dementia & psychiatric illness may interfere with a patient's ability to make informed decisions regarding medical treatment, self-care or issues such as finances
• decisional capacity is decision-specific

Notes

• requirements

• able to understand relevant informaton
• ability to appreciate the situation & its consequences
• able to rationally manipulate information
• able to communicate

• capacity may be gained or lost, requiring re-evaluation; clinical maneuvers may enhance capacity

• depression: pharmaceuticals, psychotherapy
• delirium: treat underlying disorder
• psychosis: pharmaceuticals
• cultural mismatch: seek culturally competent communication style

• capacity may be decision-specific, i.e. decisions which entail a greater risk of harm may require stricter standards for capacity
• geriatricians have the ability to determine decision-making capacity in most cases

• either psychiatry &/or neurology input is sometimes helpful
• any physician can determine if a patient has decision-making capacity [3]

• minors who are not living independently of parents, not married, & not in the armed forces cannot legally make there own medical decisions [3]
• if a patient is incapable of decision-making capacity

• a surrogate decision maker is identified
• the surrogate makes medical decisions for the patient

• substituted judgement:

• the decision the surrogate believes the patient would have made

• best interest:

• the decision the surrogate believes best for the patient [3]

• competence is a legal term

More General Terms

• decision making
• capacity

Additional Terms

• advance directives
• autonomy
• competence
• medical ethics

References

1. Rosenfeld K. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
2. Rosenfeld K. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 25-28, 2002
3. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
4. Assessment of Decisional Capacity and Competency, Drickamer MA, Chapter 10, In: Principles of Geriatric Medicine and Gerontology, 5th edition, Hazzard WR (ed)
5. Decision Making, Kapp M & Funaucance T, Chapter 24, Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw Hill, New York, 2000

decision-making capacity; decisional capacity