Revisiting Decision-Making Capacity

Abstract

Currently, a patient's right to self-determi-nation is protected by the legal doctrine of informed consent, which comes with a very important caveat. As Justice Schroeder of the Kansas Supreme Court in the case of Natanson v. Kline (1960) (1) wrote: " Anglo-American law starts with the premise of thorough-going self-determination. It fol-lows that each man is considered to be mas-ter of his own body, and he may, if he be of sound mind …. " This simply means that a person should have decision-making ca-pacity in order to give informed consent. Hence, a thorough understanding of deci-sion-making capacity is needed. Medical trainees of all levels are trusted with assess-ing decision-making capacity while obtain-ing informed consent, which is needed on three occasions: in treatment/procedure, when a patient refuses treatment/proce-dure, and when a patient decides on an al-ternate treatment/procedure. It is often believed that an experienced physician can assess decision-making capacity simply by following a gut feeling. However, when a physician encounters a case of questionable decision-making capacity, a focused assess-ment is necessary. ASSESSMENT OF DECISION-MAKING CAPACITY The first and foremost criterion for deci-sion-making capacity is that a patient can make a decision and be able to convey it. Additionally, the patient should be able to acknowledge the problem and possi-ble solutions. Decision-making capacity reflects functional abilities that a person needs to possess in order to make a spe-cific decision (2). The patient should be able to provide a rationale for his or her decision. The patient can reject medi-cal advice if he or she can understand the consequences and be able to express them. It is not wrong for physicians to persuade the patient toward an optimal treatment. However, coercion or decep-tions should be avoided.