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When a Patient Is at Foreseeable Risk of Losing Decisional and Functional Capacity.

Matthew Robert Dernbach1, Peter Ash2, Esther Oyerinde2

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Patients may have current decisional capacity but face future incapacitation due to nonadherence. This study introduces "foreseeable risk of losing capacity" to address this gap in medical treatment consent.

Keywords:
advance directivecapacityforeseeabilityguardianshippower of attorneysurrogate decision maker

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Area of Science:

  • Medical Ethics
  • Neuroscience
  • Legal Medicine

Background:

  • The four-skills model of decisional capacity is standard for informed consent.
  • Current assessments focus on a single point in time.
  • Recurrent nonadherence poses a risk of future incapacity.

Purpose of the Study:

  • To address the gap in evaluating patients with recurrent altered mental status and nonadherence.
  • Introduce the concept of "foreseeable risk of losing decisional and functional capacity."
  • Discuss clinical evaluation and implications for capacity determination.

Main Methods:

  • Literature review and conceptual analysis.
  • Identification of a novel risk factor.
  • Discussion of clinical scenarios and interventions.

Main Results:

  • A new risk factor, "foreseeable risk of losing decisional and functional capacity," is proposed.
  • Clinical evaluation strategies for patients at risk are outlined.
  • Implications for present capacity determination are considered.

Conclusions:

  • Foreseeable risk is a crucial factor in assessing decisional capacity for nonadherent patients.
  • Interventions are needed to protect patient rights and safety.
  • Adapting capacity assessment models is necessary for complex clinical situations.