Assessing competence to make treatment decisions

The legal doctrine of informed consent dictates that all patients must be informed of the procedures, risks and benefits of any recommended treatment and available alternatives, and that patients' decisions must be informed, voluntary and competent. Assessing whether or not one's patient is competent to make treatment decisions, however, is a complex task even for highly trained clinicians. Although all patients are presumed to be competent unless demonstrated otherwise, the rate of incompetence is increased in a number of patient populations such as the elderly, psychotic patients, the mentally retarded and individuals with severe medical disorders (e.g., cancer, AIDS). This paper offers guidelines for assessing the decision-making capacity among medical and psychiatric patients, as well as discussing disposition issues when decision-making abilities are indeed impaired.