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The Capacity to Make Medical Decisions

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Psychiatric Ethics in Late-Life Patients

Abstract

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.

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Author information

Authors and Affiliations

  1. Washington, DC VA Medical Center, Washington, DC, USA

    Sarah A. Kleinfeld

  2. Medstar Georgetown University Hospital, Washington, DC, USA

    Rohini Mehta

  3. Private Practice, Washington, DC, USA

    Edward J. Wicht

Authors
  1. Sarah A. Kleinfeld
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  2. Rohini Mehta
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  3. Edward J. Wicht
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Corresponding author

Correspondence to Sarah A. Kleinfeld .

Editor information

Editors and Affiliations

  1. New York University School of Medicine, New York, NY, USA

    Meera Balasubramaniam

  2. Yale University School of Medicine, New Haven, CT, USA

    Aarti Gupta

  3. Yale School of Medicine, New Haven, CT, USA

    Rajesh R. Tampi

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Kleinfeld, S.A., Mehta, R., Wicht, E.J. (2019). The Capacity to Make Medical Decisions. In: Balasubramaniam, M., Gupta, A., Tampi, R. (eds) Psychiatric Ethics in Late-Life Patients. Springer, Cham. https://doi.org/10.1007/978-3-030-15172-0_2

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  • DOI: https://doi.org/10.1007/978-3-030-15172-0_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-15171-3

  • Online ISBN: 978-3-030-15172-0

  • eBook Packages: MedicineMedicine (R0)

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