Tutorial - Capacity

1. What¹

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

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

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

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