Why is capacity important to physicians?
- Sometimes patients don’t want to do what their physicians want them to do
- Must have capacity to give consent
Four components of capacity
Patient must: 1- Understand info 2- Appreciate why info is relevant to their situation 3- Reason info in logical manner 4- Be able to express a choice
What is the importance of values?
- Must be consistent, stable, and affirmed by the patient
- Evaluates particular benefits and harms and their importance
*All decisions must pass value system
Who determines capacity?
Physicians
Psychologists and psychiatrists
Hospital ethics team
Legal system
What are the capacity assessment tools?
- ACE
- MacCAT-T
* document results
What is the Aid to Capacity Evaluation (ACE)?
directed clinical interview with semi-structured interview method
What is the MacCAT-T?
well validated and follows domains:
- understand
- appreciation
- reasoning
- expressing
* also semi-structured interview method but addresses four domains in order
What are the 3 components of consent?
- disclosure
- capacity
- voluntariness
What is the questions associated with disclosure?
Did the physician give the patient all the needed info necessary to make a decision?
What is the question used for capacity?
Does the patient have capacity?
What is the meaning of voluntariness?
Decision made freely, without force, coercion, or manipulation
What are the 2 types of consent?
- implicit
2. explicit
What are the two exceptions to informed consent?
- Patient voluntarily waived decision-making authority to clinician or third party
- When disclosure of information would harm the patient
Definition of Capacity
Ability to make decisions
