Assessing decision-making capacity in elderly patients: the gynecologist's role

To obtain informed consent, a physician must be able to assess a patient's capacity to consent to treatment. She must be able to understand the information, appreciate how it applies to her situation, rationally process it to make reasonable choices, and express herself. Medicine and law no longer view capacity as dichotomous (fully capable or absolutely not). Patients may be able to make some choices but not others. There is a legal point at which decision-making capacity should be transferred from a patient to a surrogate, but the patient need not be henceforth excluded from the decision-making process.