Medical Decision-Making Capacity

Chelsea Sprick, Neil Phillips, Jonathan Smith

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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

• Competency: “global decision-making capacity,” a legal determination made by a judge

Four key components to assess medical decision-making capacity

1. Choice: patient must clearly indicate a consistent choice

2. “Have you decided whether to follow the recommendation for the treatment?”

3. “Can you tell me what your decision is?”

4. Understand: Patient must grasp the fundamental meaning of the information communicated by the medical team

5. “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”

6. Appreciate: the medical condition and likely consequences of treatment options

7. “What do you believe is wrong with your health now?”

8. “What is treatment likely to do for you?”

9. “What do you believe will happen if you’re not treated”

10. “Why do you think this treatment was recommended?”

11. Reason: patient must rationally manipulate relevant information

12. “What makes the chosen option better than the alternative?”

13. “How did you decide to accept or reject the recommended treatment?”

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

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