Decisional Capacity Flashcards
(22 cards)
Decisional Capacity definition
Possessing the ability to make and express decisions
COMPETENCE
A legal term usually meaning that a person possesses and can legally exercise decisional capacity
Limited by factors such as age, mental status and medical condition
What are the 5 components of decisional capacity?
5 components of Decisional Capacity
Knowledge and Understanding
Appreciation
Reasoning
Values, Culture and Emotion
Expression of Choice
Knowledge and Understanding
Knowledge and comprehension of facts
Appreciation
Knowing the nature and significance of the decision
Reasoning
Ability to manipulate information rationally
Ability to weigh risks, benefits, consequences and possible outcomes.
Values, Culture and Emotion
Concept of what is good for the person
Expression of Choice
Ability to convey decision to others
Decisional capacity is usually __________ unless the patient gives reason to doubt it.
assumed
Decisional capacity assessment must be case-specific, ie. tied to a particular _______ for a specific ______ at a specific _____ and time
Decisional capacity assessment must be case-specific, ie. tied to a particular decision for a specific patient at a specific place and time
Decisional capacity is considered relative.
What does that mean?
ie. more ability needed to consent to higher risk/lower benefit decisions, while less ability needed to consent to low risk/high reward decisions
Some conditions affecting decisional capacity are modifiable, while others are not
Assessment of decisional capacity is usually a _____ not legal assessment
clinical
Decisional incapacity is a common, but often unrecognized condition, especially in _____-care settings
acute
Assessment must be tied to the 5 _______ __ _____ ______ and documented as such
components of decisional capacity
What are these tests for?
Mini-Mental State Exam (MMSE)
MacArthur Competence Assessment Tool for Treatment (MacCAT-T Test)
Systematic question sets
Assesing decisional capacity
Each has limitations
Finding of ______ _______ may trigger advance directives and/or surrogate decision-maker
decisional incapacity
If decision is not urgent and conditions modifiable, attempts to modify conditions should be made and patient restored to capacity
Minors generally held incompetent legally except for which 3 situations?
- Mature minor
- emancipated minor
- Certain medical conditions
Mature minor
a. age
b. what does minor have to do?
c. what kind of care is minor in need of?
d. what about parental consent
Over age of discretion (usually 15 years old in most states)
Minor sought care independently and demonstrates capacity
Care is medically necessary for the patient’s own benefit
Good reason for lack of parental consent
Emancipated minor
Living independently of parents and not dependent on them, eg. married, military.
what type of medical conditions warrant minors to get medical stuff?
Varies by state but usually involves addiction, STD’s, and/or contraception/abortion
Competent refusal of treatment.
Who does the law side with?
Law and ethics usually favor patient’s autonomy over physician’s beneficence and/or non-maleficence
_____ ______ may imply lack of capacity and requires assessment of decisional capacity and, sometimes, treatment in spite of patient’s refusal, if surrogate not available
Irrational refusal
