DECISIONAL CAPACITY FEATURES STANDARDS TESTS AND CRITERIA

DECISIONAL CAPACITY DISTINCTION AND COMPONENTS DISTINCTION –DECISIONAL CAPACITY = MORAL CONCEPT DETERMINED BY PHYSICIAN (PSYCHIATRIST) –COMPETENCE = LEGAL CONCEPT DETERMINED BY JUDGE COMPONENTS –COMMUNICATING CHOICES –UNDERSTANDING RELEVANT INFORMATION –APPRECIATING THE SITUATION AND ITS CONSEQUENCES –MANIPULATING INFORMATION RATIONALLY

TESTS FOR CAPACITY EVIDENCING A CHOICE (YES OR NO) REASONABLE OUTCOME OF CHOICE RATIONAL REASONS (QUALITY OF THINKING) ABILITY TO UNDERSTAND –GRASP, PROCESS, WEIGH ALTERNATIVES, ETC. –ANALOGOUS TO INFORMED CONSENT ACTUAL UNDERSTANDING (EXPERT KNOWELDGE)

TESTS FOR CAPACITY PATIENT VULNERABILITY

DECISIONAL CAPACITY HASTINGS CENTER GUIDELINES (1987) CONDITIONS –ABILITY TO COMPREHEND INFORMATION RELEVANT TO A DECISION –ABILITY TO DELIBERATE ABOUT CHOICES IN ACCORDANCE WITH PERSONAL VALUES –ABILITY TO COMMUNICATE (VERBALLY OR NONVERBALLY) WITH CAREGIVERS

DECISIONAL CAPACITY HASTINGS CENTER (1987) STANDARDS –OUTCOMES: CONTENT AND CONSEQUENCES OF THE PATIENTS TREATMENT CHOICES –STATUS OR CATEGORY: PATIENTS WITH CERTAIN CHARACTERISTICS (E.G. DEMENTIA) –PROCESS: PATIENTS EXERCISE OF PARTICULAR ABILITIES IN THE DECISION- MAKING PROCESS

DECISIONAL CAPACITY HASTING CENTER (1987) PRINCIPLE –THE MORE HARMFUL THE CONSEQUENCES TO THE PATIENT RESULTING FROM HIS/HER CHOICE, THE HIGHER SHOULD BE THE LEVEL OF CAPACITY REQUIRED AND THE GREATER THE LEVEL OF CERTAINTY SHOULD THE PROFESSIONAL HAVE ABOUT THE ASSESSMENT OF CAPACITY.