Decisionmaking capacity vs competence

Is competence and capacity the same? Competence is a legal term. Competence is presumed unless a court has determined that an individual is incompetent. What is capacity and competency? A judicial declaration of incompetence may be global, or it may be limited (e.g., to financial matters, personal care, or medical decisions).

To have decision-making capacity that is so impaired that the person is unable to make, communicate or carry out important decisions concerning the individual’s financial affairs.

Competency “ Capacity ” and “ competency ” are terms that are often used interchangeably. Although the Code of Medical Ethics does not have much to say about mental health per se, the Code does consider patient decision-making capacity , mental competence , and surrogate decision making for those who are unable—over the short term or the long term—to make their own health care decisions. These concepts are discussed in opinions 5. Withholding or Withdrawing Life-Sustaining. A 79-year-old male with coronary artery disease, hypertension, non-insulin-dependent mellitus, moderate dementia, and chronic renal insufficiency is admitted after a fall evaluation. He is widowed and lives in an assisted living facility.

He’s accompanied by his niece, is alert, and oriented to person. His labs are notable for potassium of 6.

See full list on the-hospitalist. Hospitalists are familiar with the doctrine of informed consent—describing a disease, treatment options, associated risks and benefits, potential for complications, and alternatives, including no treatment. Not only must the patient be informe and the decision free from any coercion, but the patient also must have capacity to make the decision. Hospitalists often care for patients in whom decision-making capacity comes into question.

This includes populations with depression, psychosis, deme. It is important to differentiate capacity from competency. Competency is a global assessment and a legal determination made by a judge in court. Capacity , on the other han is a functional assessment regarding a particular decision.

Capacity is not static, and it can be performed by any clinician familiar with the patient. A hospitalist often is well positioned to make a capacity determination given established rapport with the patient and familiarity with the details of the case. The Mini-Mental Status Examination (MMSE) is a bedside test of a patient’s cognitive function, with scores ranging from to 30. Buchanan A, Brock DW. MMSE has a positive LR of 15.

Guidelines for assessing the decision-making capacities of potential research subjects with cognitive impairment. American Psychiatric Association. Appelbaum PS, Grisso T. Assessing patients’ capacities to consent to treatment.

Folstein MF, Folstein SE, McHugh PR.

A practical method for grading the cogniti. The origins of our contemporary concept of decisional capacity liein a varied configuration of historical developments in health care lawand ethics that accompany the rise of the doctrine of informed consent. Allowing adultpersons and some children to make their own health care decisions is anessential component of this conception of autonomy. Comprehensive theories of decisional capacity fall into two maingroups.

Despite this variety of approaches, it is possible to identify someshared posits in leading contemporary work on decisional capacity. Veryoften, decisional capacity is divided into four sub-capacities. Two central assumptions underlie virtually all contemporary work ondecisional capacity.

These derive largely from the requirements thatthe law imposes on the ethics of informed consent. Thesignificance of this assumption is that capacity is always assessedrelative to a specific decision, at a particular time, in a particularcontext. As defined above, the term “decisional capacity” ismeant to capture a component of informed consent.

Yet while there is some agreement onwhat the sub-capacities that underlie decisional capacity are supposedto be, the same cannot be said of the term “decisionalcapacity” itself. In fact, there is a large amount ofdisagreement and confusion over whether “decisionalcapacity” is an appropriate term to refer to this element ofinformed consent. The other candidate is the term“competence. Generally, in these discussions,‘capacity’ and ‘competence’ areunderstood to mean ‘decisional capacity’ and ‘mentalcompetence’, respectively.

These terminological infelicities cancause considerable confusion but are often overlooked. One way to settle our problem is to use the terms“capacity” and “competence” interchange. A theory of decisional capacity must allow for the fact that healthcare subjects can make unpopular decisions, even ones that areconsidered highly irrational by others.

The challenge is that, whilea theory of decisional capacity must allow for such apparentlyirrational decisions, it must also embody a clear and robust test ofcapacity. It is therefore an important desideratum of an adequatetheory of decisional capacity that it permit some kinds of highlyirrational decisions, but forbid others. The most widely accepted solution to the requirement that atheory of decisional capacity permit some irrational decisions but. Part of what is involved in reasoning about a particular course ofaction and reaching a decision is weighing the risks and benefits andconsequences of proposed options. In health care contexts where consentis at issue, this normally amounts to a decisional problem that isframed in symmetrical terms: either one consents to a given treatmentoption, or one refuses that same treatment option.

This way of framingthings seems to assume that both poles of the decision are symmetricaland that mental capacity necessarily remains fixed as one evaluates thetwo options. Yet this is an assumption that can be philosophicallychallenged. It is sometimes argued that treatment decisions and refusals are notsymmetrical. The reason is that the risks respectively associated withconsenting to or refusing treatment are not the same.

In assessing claims about capacity, it is important to distinguishbetween descriptive and factual aspects of capacity on the one hanand prescriptive and normative aspects on the other. There have beensubstantial debates ove. In this example, the first claim addresses theissue whether the individual is decisionally capable. Thesecond claim addresses the issue whether the individual shouldbeconsidered decisionally capable. Note that this dual nature ofcapacity goes beyond individual judgments of capacity and extends totheories of capacity as a whole.

It is especially important not toconflate or equivocate between these two aspects of capacity whenassessing theories and determinations of capacity. At the same time,paying heed to the d. Thus, in the initial instance, a theory is built around aselection of paradigm examples of what capacity and incapacityshouldbe taken to be. We saw abovethat there are instances where the assessment of yielded byspecific tests for capacity start to merge into normative evaluativequestions that bear on the empirical validity of those tests. In fact,questions of empirical validity are a matter of increasing concern inthe recent literature on capac. The example of anorexia above shows that concerns about the empiricalvalidity of theories and tests of decisional capacity are not alwayssimply based on a clash of intuitions over paradigm cases.

A similar casecan be made for the centrality of values in conceptualizations ofvoluntarism, another pivotal ingredient of informed consent. Whichbrings us back to the topic of emotion and the status of value as anelement of capacity. Of course, emotions and their associated feelings can conflictwith and impair the mental functions that underlie capacity.

Together with decision-making capacity and the provision of relevantinformation, the capacity for voluntary choice — voluntarism— is one of the three fundamental pillars of informedconsent. The Code goes on tospecify that, “the person involved…should be so situatedas to be able to exercise free power of choice, without theintervention of any element of force, frau deceit, duress,overreaching, or other ulterior form of constraint or coercion…” (ibid.). This principle, which is meant toprotect the inviolability of the capacity for voluntary choice in thecontext of research, is also fundamental in the ethical and legalprinciples that govern the doctrine of informed consent in the contextof treatment.

Until recently, there has been a remarkable paucity of empiricalresearch on the capacity for voluntary choice in the cont. Competence on the other hand refers to the ability to perform actions needed to put decisions into effect. Questions of capacity are governed by legislation and will only apply to those who have a “mental disorder”. If capacity is questione best-interests decision making processes can be set in motion along with other legal provisions.

In a medical context, capacity refers to the ability to utilize information about an illness and proposed treatment options to make a choice that is congruent with one’s own values and preferences. Between and of requests for psychiatric consultation in hospital settings involve questions about patients’ competence to make a treatment-related decision. Approximately of adult medicine inpatients lack capacity for medical decision-making.

Some patients may have decision-making capacity for some decisions but not others. The sliding scale of competence describes differences in the threshold or “level of capacity neede” depending on the risks and benefits with which a decision may come. In addition, DMC is decision-dependent, meaning that a patient might have sufficient DMC to make a relatively straightforward decision, but not enough to make a complex medical decision. To view the entire topic, please sign in or purchase a subscription. An adult who possesses legal competence , however, may lack the capacity to make specific treatment decisions.

Physicians are mainly responsible for assessing decision-making capacity (DMC) but may encounter difficulties arising from the limited basis of evidence with regard to this concept in pediatrics. Here are two essential points everyone should understand. Capacity is decision-specific. Decision-Making Capacity for Persons with Dementia.

This means a person’s capacity should be evaluated in light of a specific decision to be made. Why does this matter?