capacity

Competence is a legal state, not a medical one. Competence refers to the degree of mental soundness necessary to make decisions about a specific issue or to carry out a specific act. All adults are presumed to be competent unless adjudicated otherwise by a court.

Capacity is defined as an individual's ability to make an informed decision.


Establishing capacity
Does the patient UNDERSTAND the nature of his medical condition and the potential CONSEQUENCES of refusing treatment and/or transport?
Assessment of DECISION MAKING CAPACITY:
Absence of deficits in:
-Cognition
-Judgment
-Understanding
-Choice
-Expression of choice
-Stability



ACDC
Autonomous decision
Capable individual
Disclosure of adequate information by provider
Comprehension of the information by individual

COMPREHENSION
“Sliding Scale” standard
The more serious the risk posed by the patient’s decision the more stringent the standard of comprehension (capacity) required.

ARTICLES
Hosp Community Psychiatry 41:1140-1141, October 1990
©1990 American Psychiatric Association
Psychiatric Evaluation of Competency in Physically Ill Patients Who Refuse Treatment
John C. Mahler, Samuel Perry, and Frank Miller

Psychosomatics 47:443-448, October 2006
doi: 10.1176/appi.psy.47.5.443
© 2006 Academy of Psychosomatic Medicine
CASE REPORTS
Involuntary Hospitalization of Medical Patients Who Lack Decisional Capacity: An Unresolved Issue

resources
http://lawprofessors.typepad.com/elder_law/2006/01/competence_vs_c.html