Embedding Ethics Into Decision-Making Capacity Assessment:An EHR-Enabled Systemwide Approach

Decision-making capacity (DMC) assessments are essential for ensuring patients' autonomy and welfare in health care. Existing literature rarely addresses how to integrate ethics into DMC assessment. To address this gap, we present a practical, ethically grounded framework for clinical DMC assessment, informed by five key considerations (who, when, where, how, and why), supported by a templated electronic health record (EHR) progress note and embedded cues and training resources for system-wide implementation. We address ethical imperatives such as obtaining consent for DMC assessments, managing patient participation, and ensuring assessments are done by the practitioner responsible for the medical decision at hand when clinically indicated, always aiming to maximize the patient's ability to demonstrate capacity.