What decision-making capacity means

Created date

February 27th, 2020

Dr. Narrett leads the medical team at all Erickson Living-managed communities. A graduate of Harvard Medical School, he has been providing care for seniors for over three decades.

Capacity is a term frequently used in discussion with health care professionals when it becomes time to make a medical decision about surgery; a medical test; or procedure for an individual with physical, emotional, or cognitive impairment. The discussion often occurs in the context of informed consent, which is a process designed to provide all necessary information to choose among medically reasonable plans or treatments for your health care. 

At the essence of informed consent is the ability to fully understand what is being presented by the medical provider and then to come to a reasoned decision. Thus, the ability to give an informed consent decision as a patient is dependent upon your decision-making capacity. 

Decision-making capacity is generally considered a medical term and not a legal one. Capacity can vary as a patient’s condition changes, and because of this, it is most relevant when it pertains to a particular situation at a particular time. For example, it is not uncommon during a hospitalization to be clear in mind one day, but then a day or two later, either because of medication or illness, be confused and incapable of making a decision. Another example occurs in the context of cognitive deficit, in which you may be considered capable of making certain decisions regarding day-to-day activities but not whether you would like to have major surgery.

Aid to Capacity Evaluation 

You can see how tricky the determination of capacity can be. You should work closely with your provider in making decisions. There are certain capabilities that must be present to establish capacity. A patient must be able to understand the relevant information about the proposed treatment or test, appreciate their current medical situation and personal values, use reason to make decisions, and be able to communicate their choices. One of the very best tools providers use in this regard is the Aid to Capacity Evaluation created by the Joint Centre for Bioethics at the University of Toronto, which poses a series of questions to evaluate understanding of the medical issue and the consequences of a decision.

Because there are times when you may be unable to effectively make a decision, it is of utmost importance to officially designate someone as your health care proxy, sometimes called a health care agent, health care power of attorney, or medical power of attorney. You can do this as a stand-alone document or as part of a series of advance planning documents, and once established, your designee can make decisions on your behalf when you may not be capable. 

Please be sure to have the important discussion with your chosen health care agent about your values and wishes so they know how best to represent you if and when the time comes when you can’t represent yourself.  It is important to note that it is not necessary to complete other advance planning documents such as a living will or financial power of attorney in order to designate your health care proxy.

The best time to name a health care proxy is now. None of us knows what will happen tomorrow, and it will give you and your loved ones peace of mind to know that you have communicated your wishes in advance.

In good health,

Dr. Narrett

Dr. Narrett leads the medical team at all Erickson Living-managed communities. A graduate of Harvard Medical School, he has been providing care for seniors for over three decades.