Assessment of Decision-Making Capacity in Adults
The capacity to make one's own decisions is fundamental to the ethical principle of respect for autonomy and is a key component of informed consent to medical treatment. Determining whether an individual has adequate capacity to make decisions is therefore an inherent aspect of all clinician-patient interactions.
The main determinant of capacity is cognition, and any condition or treatment that affects cognition may potentially impair decision-making capacity. In the presence of cognitive impairment from any cause, determining whether a patient has adequate capacity is critical to striking the proper balance between respecting patient autonomy and acting in a patient's best interest.
Who May Need a Capacity Evaluation
These skills are especially important in the care of adult patients who have diseases that impair cognition. Patients with traumatic brain injury (TBI), psychiatric illnesses (e.g., schizophrenia, bipolar disorder, and unipolar major depression), and neurodegenerative diseases are at risk for impaired capacity. Hospitalized patients and older adults are also at risk due to cognitive impairment from chronic diseases, cognitive aging, and delirium.
What We Assess
- Ability to understand relevant information about treatment or decisions
- Ability to appreciate how information applies to one's own situation
- Ability to reason about options and their consequences
- Ability to communicate a choice consistently
- Cognitive functioning (memory, attention, executive function)
- Presence of psychiatric conditions affecting judgment
Types of Capacity Evaluations
A skillful capacity assessment can help determine the severity of a patient's cognitive impairments and improve the effectiveness of conversations with patients and their families. We provide evaluations related to medical treatment decisions, financial management capacity, legal decision-making (e.g., testamentary capacity), and independent living decisions.