Decision-Making Capacity
(from Dr. Vermette)
Criteria for Capacity
- Is the patient able to communicate and make a choice?
- Does the patient have a factual understanding of the current situation? (diagnosis, prognosis, recommended treatment, risk, benefit, alternatives, no treatment)
- Does the patient appreciate the situation and its consequences? (realistic evaluation of probability of consequences, what it means for them)
- Is the patient able to rationally manipulate data to arrive at a decision? (not using delusional reasoning, logical, but doesn't have to be the decision we want)
Make a brief statement to the effect:
"Based on my evaluation of this patient, he/she [does/does not] appear to have deficits in his/her ability to make medical decisions in that he/she is [able/unable] to express and maintain a choice, [does/does not] have a factual understanding of the current situation (as evidenced by), is [able/unable] to appreciate the situation (as evidenced by) and is [able/unable] to rationally manipulate the data to arrive at a decision (as evidenced by). Therefore it is my opinion that a court would find that this patient [lacks/has capacity] to make medical decisions."
If lacking:
"If a health care proxy exists, it should be invoked at this point in time, and all medical decisions should be deferred to that person. If no health care proxy exists, the family/hopsital should pursue guardianship. In the event of a medical emergency, the patient should not be allowed to refuse life-saving treatment. If time allows, contact the family prior to treatment."
If not lacking:
"We must respect the patient's right to make his/her own medical decisions."