11-07-2010, 06:52 PM
Decision-making capacity refers to the capacity to provide informed consent to treatment.
This is different from competence, which is a legal term; competence is determined by a
court. Any physician who has adequate training can determine capacity. A patient must
meet three key criteria to demonstrate decision-making capacity: (1) the ability to understand
information about diagnosis and treatment; (2) the ability to evaluate, deliberate,
weigh alternatives, and compare risks and benefits; and (3) the ability to communicate a
choice, either verbally, in writing, or with a nod or gesture. In eliciting patient preferences,
the clinician should explore the patient’s values. This patient met these three criteria when
he made his decision about advance directives, and his wishes should be respected. There
is no need for an ethics consult under these circumstances. Fear of litigation should not
influence the decision to follow the patient's wishes. (Answer: B—Follow the patient's wishes
and continue with comfort measures only)
This is different from competence, which is a legal term; competence is determined by a
court. Any physician who has adequate training can determine capacity. A patient must
meet three key criteria to demonstrate decision-making capacity: (1) the ability to understand
information about diagnosis and treatment; (2) the ability to evaluate, deliberate,
weigh alternatives, and compare risks and benefits; and (3) the ability to communicate a
choice, either verbally, in writing, or with a nod or gesture. In eliciting patient preferences,
the clinician should explore the patient’s values. This patient met these three criteria when
he made his decision about advance directives, and his wishes should be respected. There
is no need for an ethics consult under these circumstances. Fear of litigation should not
influence the decision to follow the patient's wishes. (Answer: B—Follow the patient's wishes
and continue with comfort measures only)