Decision Making Capacity

Question 1

Informed consent definition

Answer 1

Involves providing patients with accurate and adequate information about risks/benefits/alternatives to a treatment that is free from coercion

Question 2

Medical decision making capacity definition

Answer 2

The ability of a patient to understand the benefits/risks/alternatives to a proposed treatment or intervention

similar to informed consent accept its the recipient this time, not the person delivery the information

Question 3

What are the 4 things a patient must be able to do in order to have medical capacity

Answer 3

1) demonstrate UNDERSTANDING of the benefits/risks/alternatives to a proposed treatment or intervention
2) demonstrate APPRECIATION of those benefits/risks/alternatives
3) show REASONING in making a decision
4) COMMUNICATE their choice

Question 4

Capacity vs competence

Answer 4

Capacity

• doctors determine this
• ability to make decisions for themselves only

Competence

• judges determine this
• ability to provide for themselves and make decisions

Question 5

Risk factors for impaired medical decision-making capacity

Answer 5

• fear or discomfort of the health care setting in general

Age either <18 or >85

Presents with chronic neurologic or chronic psychiatric condition

Low education level

Significant cultural language barrier

Question 6

Barriers to communication

Answer 6

Language barriers

“Pseudo-incapacity”
- cant make a medical decision because they dont understand what your saying

Hearing/vision impairment

Dysphagia/dysarthria

all of these can be barriers towards proper informed consent and determine capacity

Question 7

Reversible causes of impaired decisional capacity

Answer 7

Infections

Medication adverse effects

Illicit drugs (toxicity and withdrawal)

Hypoxia

Metabolic derangement

Acute neurologic disorders

Delirium

Critical illness

Question 8

Does the patient have to make the “right” choice in order to be deemed having decision making capacity?

Answer 8

NO

Question 9

What should you ask the patient for if you need to make a final decision on a medical procedure, but the patient doesn’t have the capacity to make the decision?

Answer 9

1) do they have an advance directive?
2) do they have a medical power of attorney?
3) is there a surrogate decision maker available (* in this specific order: spouse, adult children, parents, siblings, other relatives*)

4) is there a court-appointed health surrogate decision maker
- get in touch with legal and they apppoint them

5) treating physician
- only done in an emergency situation that needs to be taken care of NOW*
- need to get another physician to sign off saying this was the logical step to take to save the patient**