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General Medicine

Capacity (Competence) Determination and Informed Consent

Sandra N New, DNP Reviewed 04/2024
 


BASICS

  • Personal autonomy in decision making is a fundamental personal freedom.

  • Capacity determination is an inherent element of the informed consent process.

  • It is universally presumed that patients 18 ...

DIAGNOSIS

In patients without capacity, physicians are unable or unwilling to recognize the incapacity 42% of the cases (1)[C]. 

HISTORY

Family or frequent observers are resources regarding behavior pa...

TREATMENT

GENERAL MEASURES

Steps to take if a patient fails to have capacity or fails to display ability to participate in informed consent: 

  • Determine the acuity of the need for decision making: (e.g.,...

ONGOING CARE

The following in rank order, have responsibility for medical decision-making /informed consent if patient lacks capacity: 

  • Spouse (unless legally separated)

  • Adult child

  • A parent

  • An adult sibl...

REFERENCES

1
Barstow C, Shahan B, Roberts M. Evaluating medical decision-making capacity in practice. Am Fam Physician. 2018;98(1):40–46.
2
Yadav KN, Gabler NB, Cooney E, et al. Approximately one in thre...

CODES

SNOMED

  • 203031000000107 Informed consent given

  • 768021000000109 Finding of capacity to give consent

  • 32082000 Competence

CLINICAL PEARLS

  • Use a structured approach to assessing decision-making capacity, including an assessment of language barriers, identification and remediation of reversible causes of incapacity and a c...

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