● There are currently no formal practice guidelines from professional societies for the assessment of a patient's capacity to consent to treatment.

● Any physician can declare someone with capacity & competence. In certain legal settings, some attorneys, judges will require a physician trained in a specific clinical specialty (neurology, psychiatry, etc) to evaluate competency.

● Capacity and competence are present when the individual can do the following 5 domains: clearly communicate a preference/desire; understands information about a situation or condition; understands the various options available; understands the consequences of her choices; weighs the risks and benefits of their choice. You can "confirm" understanding through "Teach Back", i.e. ask the person to state in their own words their understanding of the consequences, available options, and risks/benefits of their choice. "To make sure I understand you well, what do you see as the consequences of the choice, alternative options available to you, and the risks and benefits of your choice?"

● Evaluate for and rule out severe depression and active substance use

● Even if the person has depression and mild cognitive impairment/dementia, they can still be considered competent to make decisions & exercise decision-making.

● Available validated tool: MacArthur Competence Assessment Tool

● “Capacity” is a medical judgment & competence is a legal judgment. (Harvard CME)

Version: YT 11/2024