Medical decision-making capacity refers to the patient’s ability to make informed decisions regarding their care, and emergency physicians are frequently required to assess whether a patient possess this capacity. Patients with acute or chronic neurological diseases (such as dementia) may lack this capacity, and this should be identified, especially in life-threatening situations. The patient must have the ability to:
communicate a consistent choice
understand (and express) the risks, benefits, alternatives and consequences
appreciate how the information applies to the particular situation
reason through the choices to make a decision
There are numerous tools that may help with this assessment, but none has been validated in the ED. Be careful of determining that the patient lacks capacity just because of the diagnosis they carry.
BONUS PEARLS:
Capacity is a fluid concept; a patient may have the capacity to make simple decisions but not more complex ones. Capacity may also change over time
Psychiatry consultation to determine capacity is not obligatory but may be utilized for a second opinion.
Rodgers JJ, Kass JS. Assessment of Medical Decision-making Capacity in Patients With Dementia. Continuum 2018;24(3):920–925.