What is capacity and competence? Are competence and competence same? Does this patient have medical decision-making capacity?
Although the terms are often used interchangeably, competence is a legal term that is determined by the court system , whereas capacity is a medical term that is. However, health care practitioners play an important role in the assessment process. In the US, people aged or older are presumptively considered legally capable of making health care decisions for themselves.
The key distinction set out by Willner is that mental capacity refers to the ability to make decisions. Capacity is the ability to understand the nature and effect of one’s acts. Questions of capacity are governed by legislation and will only apply to those who have a “mental disorder”. A judicial declaration of incompetence may be global , or it may be limited (e.g., to financial matters, personal care, or medical decisions). Decision-making capacity, on the other han is a clinical term that is task-specific.
A 79-year-old male with coronary artery disease, hypertension, non-insulin-dependent mellitus, moderate dementia, and chronic renal insufficiency is admitted after a fall evaluation. Competence is a legal term. He is widowed and lives in an assisted living facility.
He’s accompanied by his niece, is alert, and oriented to person. His labs are notable for potassium of 6. See full list on the-hospitalist. Hospitalists are familiar with the doctrine of informed consent—describing a disease, treatment options, associated risks and benefits, potential for complications, and alternatives, including no treatment.
Not only must the patient be informe and the decision free from any coercion, but the patient also must have capacity to make the decision. Hospitalists often care for patients in whom decision-making capacity comes into question. This includes populations with depression, psychosis, deme. It is important to differentiate capacity from competency.
Capacity , on the other han is a functional assessment regarding a particular decision. A hospitalist often is well positioned to make a capacity determination given established rapport with the patient and familiarity with the details of the case. The Mini-Mental Status Examination (MMSE) is a bedside test of a patient’s cognitive function, with scores ranging from to 30. Buchanan A, Brock DW. MMSE has a positive LR of 15.
Guidelines for assessing the decision-making capacities of potential research subjects with cognitive impairment. American Psychiatric Association. Appelbaum PS, Grisso T. Assessing patients’ capacities to consent to treatment. Folstein MF, Folstein SE, McHugh PR.
A practical method for grading the cogniti. In a medical context, capacity refers to the ability to utilize information about an illness and proposed treatment options to make a choice that is congruent with one’s own values and preferences. Mr Le Grand said GPs should tell the patient about the process as to what they are being instructed to do. All adults are presumed to be competent unless adjudicated otherwise by a court. Although the Code of Medical Ethics does not have much to say about mental health per se, the Code does consider patient decision-making capacity , mental competence , and surrogate decision making for those who are unable—over the short term or the long term—to make their own health care decisions.
These concepts are discussed in opinions 5. Withholding or Withdrawing Life-Sustaining. As an adjective capacity is filling the allotted space. Therefore, requests for determination of decisional capacity in the clinical setting should be specific to an individual decision or set of decisions. In contrast, competence is an enduring legal determination of incapacitation, typically made by a probate judge.
Clinical standards for addressing capacity. A determination of competency is a judicial finding made by the court. A physician can opine about a patient’s capacity, but cannot determine competency. Adults are presumed to have capacity unless determined otherwise by the court.
Decisional capacity is the ability to consent to or refuse care. It is closely related to competence, which can only be determined in a court of law. Capacity and competency — Capacity describes a person’s ability to a make a decision.