Decision-Making Capacity and Consent in the Older Adult

  • Gail Jamieson


Age is the most important risk factor for cognitive impairment. In dealing with older adults with cognitive impairment, the question of capacity to make decisions in various areas of their lives may arise. Consequently the physician is frequently faced with ethical dilemmas when managing the elderly. The aim of this chapter is not only to create awareness of these problems but also to provide a practical approach to assessment, using principles that can be applied to all types of decisions where capacity may be questioned. These include medical consent, lifestyle decisions, financial decisions and execution of legal documents such as enduring guardian and power of attorney appointments, making of a will and entering into a contract. The terms ‘competency’ and ‘capacity’ are frequently used interchangeably, and it is important to have an understanding of these terms and how they are being used when interpreting literature as well as clinical and legal reports. Historically, decision-making capacity is clinically determined by a physician’s assessment, whereas competence and incompetence are legal designations determined by the courts. Capacity to make one’s own decisions is fundamental to the ethical principle of respect of autonomy. When faced with a person with a disability, autonomy needs to be balanced with ensuring patients do what is in their best interests and are not denied treatment and protection. This chapter also provides a simplified flowchart guide to decision-making capacity.


Life expectancy Competence Decision-making capacity Informed consent 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gail Jamieson
    • 1
  1. 1.GeriatricianSydneyAustralia

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