Tutorial - Capacity

Table of Contents

1. What1

1.1. capacity

  • ability of a patient to make informed decisions and consent to receive medical treatment as assessed by any physician
  • decided by a physician
  • focused on a particular area: e.g. financial, medical
  • Accurate and timely documentation, including a mental status examination in the medical record is mandatory in all cases regarding patient competency, especially when the patient refuses the recommended treatment

1.2. competence

  • competency is a patient’s legal capacity to engage in the decision-making process regarding his or her medical care.
  • decided by a judge
  • more comprehensive than capacity
  • capacity informs competence
  • By law, all adults are presumed competent unless otherwise determined by a court of law
  • Competency is a medicolegal determination and should not be used to coerce a patient into treatment

1.3. notes

  • sometimes used interchangeably

2. Why

2.1. informed consent

  • The doctrine of informed consent mandates that a patient must voluntarily give permission to receive or deny medical or psychiatric treatment
  • must be competent, therefore need to assess for capacity

3. How1

  • CPS "Procedures for assessing capacity"
  • A patient must be able to
    • understand the basic information necessary to make a decision
    • understand alternative treatment strategies available
    • appreciate the consequences of treatment and of no treatment
    • integrate all of the relevant information to make a consistent decision on their own behalf
  • standard for capacity may be affected by risk-to-benefit ratio of the proposed treatment
  • If not found competent, Substitute Decision Maker Act2 can be invoked
    1. Health care directive (Part II, page 6)
    2. Proxy (part III, page 10, section 13(3) most important)
    3. SDM: in order of closeness (section 15(1), page 12)
  • Some patients may need additional help when determining capacity
    • make sure sensory devices (glasses, hearing aids) are being used
    • speak slowly, ensure reception of the content
    • quiet place
    • repeat as necessary
    • ask to repeat in their own words, correct as necessary


Author: Armin

Created: 2022-07-13 Wed 21:36