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The Capacity Conundrum in Emergency Medicine
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Journal Article
The Capacity Conundrum in Emergency Medicine
2019
Overview
• Patients are presumed to be capable of making choices for themselves, unless proven otherwise; the physician is required to determine incapacity. • Capacity is essential for valid consent for medical care and treatment. • Capacity is NOT a test result, diagnosis, or score on an assessment tool. • Capacity involves the process of decision making and does not depend on the specific choice that is made. • Capacity assessment focuses on the specific abilities that a patient requires to make a decision about a specific situation. • People who are capable can make rational decisions that are based on their values and goals, as well as on their knowledge and understanding of the issues they face. Capable people can identify and accept risks. • Capacity is not one ability that people have or do not have. People employ different abilities to make different types of choices. Capacity is specific to the task. • Assessment of capacity is domain-specific; six recognized domains are healthcare, nutrition, clothing, shelter, hygiene, and safety. Patients may have capacity in one domain but they may lack capacity in another. • Assessing capacity requires considering the whole person — it is not related to an illness, a diagnosis, or a living situation. Being homeless, being a resident of a long-term care facility, or abusing drugs or alcohol does not automatically render a patient incapable of medical decision making. • Assessment of capacity relates to two ethical principles: the need to balance autonomy (self-determination) and beneficence (protection). • Incapacity often is reversible. Illnesses and intoxications can temporarily impair capacity. Patients can regain capacity on recovery.
Publisher
Relias Learning
Subject
