The Capacity to Make Medical Decisions
This chapter examines the core components of a capacity evaluation, the consequences of determining a patient lacks capacity, and issues commonly arising in clinical practice, specifically focusing on elderly individuals and those with dementia. There are four central components that patients must possess to be considered capacitated: (1) a basic understanding of the relevant medical background and circumstances; (2) an appreciation of the risks, benefits, and consequences of possible choices; (3) the ability to communicate a choice; and (4) communicating the rationale for arriving at that decision (Appelbaum and Grisso, NEJM. 319:1635–38, 1988). How these components are assessed and analyzed in the context of a clinical interview is examined in greater detail throughout the chapter. Understanding ways to appropriately assess capacity is particularly important for providers caring for patients with dementia, as this may be a frequent clinical concern. Evidence-based tools for assessing cognition and capacity and their role in a thorough capacity evaluation are also reviewed.
KeywordsCapacity Informed consent Medical decision-making Dementia Cognitive assessment tools Capacity assessment tools
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