Capacity

Background

• Capacity is the ability to understand the nature and effect of one’s acts
  • May have capacity in one moment and lack capacity in another
• Main question to consider is "does the patient have the ability to understand the nature and effect of his or her acts in a specific moment in time?"
• Mini mental status exam (MMSE) score <19 is correlated with lack of capacity
• Patients who lack capacity may not make their own medical decisions.

Components

• Must have all four criterion to achieve capacity
• Criterion 1 - communicate a choice
  • Clearly demonstrate preference for a treatment option
  • Reversals of choice due to altered mental status or psychiatric disease suggests lack of capacity
• Criterion 2 - understand relevant information
  • Grasp fundamental understanding of information communicated by physician
  • Must understand condition, purpose of treatment, benefits/risks of treatment, and alternatives
• Criterion 3 - appreciate situation and its consequences
  • Acknowledge medical condition (no denial, delusions)
  • No acknowledgement termed "lack of insight"
    • "What do you believe is wrong with your health now?"
    • "Do you believe that you will need treatment to make your health better?"
    • "What do you believe will happen if you are not treated?"
    • "Why do you think doctors recommend this treatment?"
• Criterion 4 - reason about treatment options
  • Demonstrate rational processing of relevant information communicated by physician
    • "What makes treatment 1 better than treatment 2?"
    • "How did you decide to accept or reject recommended treatments?"

See Also

• Competence
• Emancipated minor