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
  • Does the patient have the ability to understand the nature and effect of his or her acts in a specific moment in time?
• The level of capacity needed to enter into legal documents, such as a durable power of attorney, contract, or a will, differs based upon the type of transaction
• Use to consent to medical procedures
• Mini mental status exam (MMSE) <19 are correlated with lack of capacity

Application

• For medical consent, does the patient have the ability to:
  • Communicate
  • Understand the medical procedure
    • Understand a description of the procedure, its risks, its benefits, and its alternatives?
  • Voluntarily consent?
  • Give consent because he or she is competent?

Four Components

• Must have all four criterion to achieve capacity

1. 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
2. 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
3. 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?"
4. 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