A Guide to the Assessment and Care of the Patient Whose Medical Decision-Making Capacity is in Question

In general terms, medical-decision-making "capacity" is the ability to give informed consent to accept a medical intervention or to make an informed refusal of the intervention. This article presents a method to guide physicians who assess and care for patients whose medical decision-making capacities are in question. The guide relies on legal and ethical principles pertaining to informed consent. The guide recommends a specific definition of capacity. Relying on that definition, the guide employs the best empirically validated bedside tests of the neuropsychiatric elements of capacity: attention, language, memory, and frontal-lobe functions (awareness and judgment). This article accomplishes 5 things that previously published capacity-assessment instruments do not do: (1) guides the physician in assessing attention, language, memory and general frontal-lobe functions; (2) guides the physician in assessing certain elements of capacity that are legally required in certain cases in some jurisdictions; (3) defines and recommends a specific standard of judgment; (4) guides the physician in caring for the patient beyond the point of simply rendering a decision about capacity; and (5) guides the physician in dealing with the complex legal issues surrounding the assessment of capacity.