Rethinking the Assessment of Decision-Making Capacity and Making Treatment-Related Decisions

An accurate determination of an individual's decision-making capacity is fundamental to obtaining informed consent for medical treatment, as it allows clinicians to balance respect for patients' autonomy with the best interests of patients. Despite the increasing demand for assessments of patients' capacity, healthcare professionals find this task complex and challenging. Currently, assessments are largely based on patients' cognitive ability and do not sufficiently take into account other factors that influence patients' judgment. Furthermore, it is important to assess for and treat modifiable factors that impair decision-making capabilities, and to have guidance on when it is appropriate to delay treatment-related decisions. This article will review current methods for assessing capacity, highlight other factors to consider in the decision-making process, and propose an enhanced framework to guide clinicians in making timely and prudent treatment-related decisions for patients with impaired capacity.