Medical Decision-Making Capacity

Medical Decision-Making Capacity – Chelsea Sprick, Neil Phillips, Jonathan Smith

  • Capacity can be assessed by any physician regarding a pt’s ability to make a specific medical decision at a specific point in time 
  • Competency: “global decision-making capacity,” a legal determination made by a judge
  • 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

 

Assessing medical decision-making capacity

  • 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: pt 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: the medical condition and likely consequences of treatment options
    • “What do you believe is wrong with your health now?”
    • “What is treatment likely to do for you?”
    • “Do you believe you need treatment?”
    • “What do you believe will happen if you’re not treated”
    • “Why do you think this treatment was recommended?”
  • Reason: patient must rationally manipulate relevant information
    • “What makes the chosen option better than the alternative?”
    • “How did you decide to accept or reject the recommended treatment?”

 

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