Decision-Making Capacity and Consent in the Older Adult
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.
KeywordsLife expectancy Competence Decision-making capacity Informed consent
- 2.Kour NW, Rauff A. Informed patient consent historical perspective and a clinician’s view. Singap Med J. 1992;33(1):44–6.Google Scholar
- 3.Kara MA, Aksoy S. On the Ottoman consent documents for medical interventions and the modern concept of informed consent. Saudi Med J. 2006;27(9):2306–10.Google Scholar
- 5.Standford Encyclopedia of Philosophy. Decision-making capacity. 2011. https://plato.stanford.edu/entries/decision-capacity. Accessed 12 July 2017.
- 6.World Health Organisation. Facts about aging. www.who.int/ageing/about/facts/eu. Accessed 8 July 2017.
- 7.Christensen J, Willingham V. Live to 100. Number of centenarians doubled. Edition. cnn.com/2014/06/04/health/centenarian-death/index.html. Accessed 67 July 2017.
- 8.www.cdc.gov/aging/pdf/cognitive_impairment/cogimp_poicy_inall.pdf. Accessed 8 July 2017.
- 10.Karlawish J. Assessment of decision-making capacity in adults. 2017 UpToDate. http://www.uptodate.com/contents/assessment-of-decision-making-capacity-in-adults. Accessed 8 July 2017.
- 13.Life in the fast lane. Capacity and competence. https://lifeinthe.fastlane.com.ccc/capacity-and-competence. Accessed 8 July 2017.
- 15.Lowenkopf EL. Legal issues of geriatric patients: competency and decision making. Geriatric Times. 2001;2(9). http://www.cmellc.com/geriatrictimes/g011133.html. Retreived on 1 April 2009.
- 16.Jones. A guide to assessing decision making capacity. Clev J Med. 2004;1–5.Google Scholar
- 21.Stewart C, Kerridge I, Parker M. The Australian medico-legal handbook. 1st ed. Marrickville: Church Livingstone Elsevier; 2007.Google Scholar
- 22.Zabow T. Will and curators-decision –making in adults with impaired capacity. CME. 2012;30(4). http://www.cmej.org.za/index.php/c,ej/article/niew/2404/2276. Accessed on 20 Oct 2013.
- 23.Kelly TB. Paternalism and marginally competent: an ethical dilemma. No easy answers. J Gerontol Social Work. 1994;23(1/2):67–84.Google Scholar
- 27.NSW Government –Justice. Section 2-what is capacity. http://www.justice.nsw.gov.au/diversityservices/Pages/Diversv/ds_capacity_tool/ds_capa_whatis.aspx. Accessed 11 July 2017.
- 28.Uptodate Assessment of decision making capacity in older adults. www.uptodate.com/contents/assessment-of-decision-making-capacity-in-adults. Accessed 23 Sept 2017.
- 29.Venesy BA. A clinician’s guide to decision making capacity and ethically sound medical decisions. Am J Phys Med Rehabil. 1994;73(3):26.Google Scholar
- 31.Grisso T, Appelbaum PS. MacArthur competence assessment tool for treatment (MacCAT-T). Sarsota: Professional Resource Press; 1998.Google Scholar
- 35.Nagaratnam N, McNeil C. Dementia in the severely aphasic: global aphasia without hemiparesis-a stroke subtype simulating dementia. Am J Alz Dis. 1999;14:74–8.Google Scholar
- 36.McAuliffe J. Presentation guardianship division training Mar 2016 – capacity assessment a neuropsychologists perspective. BalmainGoogle Scholar