Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians

Overview

Journal Prim Care Companion J Clin Psychiatry

Specialty Psychiatry

Date 2004 Mar 12

PMID 15014674

Citations 18

Authors

Raphael J Leo

Affiliations

Soon will be listed here.

Abstract

Common law dictates that individuals possess autonomy and self-determination, which encompass the right to accept or refuse medical treatment. Management of medical treatment can be complicated in situations when the ability of the patient to make reasonable decisions is called into question. Our legal system endorses the principle that all persons are competent to make reasoned decisions unless demonstrated to be otherwise. This review will discuss the standards upon which capacity and competency assessments are made. Practical suggestions are offered for clinicians to employ in patient interviews conducted to assess capacity. Issues related to advance directives, surrogate decision making, guardianship, and implied consent are also discussed. The role psychiatric consultants take in capacity assessment can assist the primary care physician confronting the complexities encountered when attempting to treat the incapacitated or incompetent patient.

Citing Articles

What competencies does an orthodontic postgraduate need?.

Mahdavifard H, Noorollahian S, Omid A, Yamani N BMC Med Educ. 2024; 24(1):1461.

PMID: 39695531 PMC: 11654387. DOI: 10.1186/s12909-024-06475-y.

Impact of nitrous oxide use on parturient recall of neuraxial analgesia risks.

Sharpe E, Warner L, Brakke B, Davis P, Finkel D, Burkle C J Clin Anesth. 2024; 98:111579.

PMID: 39128257 PMC: 11392610. DOI: 10.1016/j.jclinane.2024.111579.

Mobile Phone Use by People with Mild to Moderate Dementia: Uncovering Challenges and Identifying Opportunities: Mobile Phone Use by People with Mild to Moderate Dementia.

Dixon E, Michaels R, Xiao X, Zhong Y, Clary P, Narayanan A ASSETS. 2023; 2022.

PMID: 37283282 PMC: 10202486. DOI: 10.1145/3517428.3544809.

To resuscitate or not to resuscitate? The crossroads of ethical decision-making in resuscitation in the emergency department.

Kumar N, Fatima M, Ghaffar S, Subhani F, Waheed S Clin Exp Emerg Med. 2023; 10(2):138-146.

PMID: 37188357 PMC: 10350361. DOI: 10.15441/ceem.23.027.

From text to interaction: The digital advance directive method for advance directives.

Biller A, Biller-Andorno N Digit Health. 2023; 9:20552076221147414.

PMID: 36620435 PMC: 9817014. DOI: 10.1177/20552076221147414.

References

Bean G, Nishisato S, Rector N, Glancy G . The assessment of competence to make a treatment decision: an empirical approach. Can J Psychiatry. 1996; 41(2):85-92. DOI: 10.1177/070674379604100205. View

Drane J . Competency to give an informed consent. A model for making clinical assessments. JAMA. 1984; 252(7):925-7. View

Kapp M . Advocacy for the mentally impaired elderly: a case study analysis. Am J Law Med. 1989; 14(4):353-76. View

Emanuel E, Emanuel L . Proxy decision making for incompetent patients. An ethical and empirical analysis. JAMA. 1992; 267(15):2067-71. View

Stanley B, Stanley M, GUIDO J, Garvin L . The functional competency of elderly at risk. Gerontologist. 1988; 28 Suppl:53-8. DOI: 10.1093/geront/28.suppl.53. View

Appelbaum P, Roth L . Competency to consent to research: a psychiatric overview. Arch Gen Psychiatry. 1982; 39(8):951-8. DOI: 10.1001/archpsyc.1982.04290080061009. View

Mahler J, Perry S . Assessing competency in the physically ill: guidelines for psychiatric consultants. Hosp Community Psychiatry. 1988; 39(8):856-61. DOI: 10.1176/ps.39.8.856. View

Lippert G, Stewart D . The psychiatrist's role in determining competency to consent in the general hospital. Can J Psychiatry. 1988; 33(4):250-3. DOI: 10.1177/070674378803300403. View

Fogel B, Mills M, Landen J . Legal aspects of the treatment of delirium. Hosp Community Psychiatry. 1986; 37(2):154-8. DOI: 10.1176/ps.37.2.154. View

10.

Roth L, Meisel A, Lidz C . Tests of competency to consent to treatment. Am J Psychiatry. 1977; 134(3):279-84. DOI: 10.1176/ajp.134.3.279. View

11.

Abernethy V . Compassion, control, and decisions about competency. Am J Psychiatry. 1984; 141(1):53-8. DOI: 10.1176/ajp.141.1.53. View

12.

Appelbaum P, Grisso T . Assessing patients' capacities to consent to treatment. N Engl J Med. 1988; 319(25):1635-8. DOI: 10.1056/NEJM198812223192504. View

13.

Golinger R, Fedoroff J . Characteristics of patients referred to psychiatrists for competency evaluations. Psychosomatics. 1989; 30(3):296-9. DOI: 10.1016/S0033-3182(89)72275-1. View

14.

Griffith D . The best interests standard: a comparison of the state's parens patriae authority and judicial oversight in best interests determinations for children and incompetent patients. Issues Law Med. 1991; 7(3):283-338. View

15.

Grisso T, Appelbaum P . The MacCAT-T: a clinical tool to assess patients' capacities to make treatment decisions. Psychiatr Serv. 1997; 48(11):1415-9. DOI: 10.1176/ps.48.11.1415. View

16.

Emanuel L, Barry M, STOECKLE J, Ettelson L, Emanuel E . Advance directives for medical care--a case for greater use. N Engl J Med. 1991; 324(13):889-95. DOI: 10.1056/NEJM199103283241305. View

17.

Pfeiffer E . A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975; 23(10):433-41. DOI: 10.1111/j.1532-5415.1975.tb00927.x. View

18.

Lee M, Ganzini L . The effect of recovery from depression on preferences for life-sustaining therapy in older patients. J Gerontol. 1994; 49(1):M15-21. DOI: 10.1093/geronj/49.1.m15. View

19.

Beck A, Brown G, Berchick R, STEWART B, Steer R . Relationship between hopelessness and ultimate suicide: a replication with psychiatric outpatients. Am J Psychiatry. 1990; 147(2):190-5. DOI: 10.1176/ajp.147.2.190. View

20.

Bostwick J, Masterson B . Psychopharmacological treatment of delirium to restore mental capacity. Psychosomatics. 1998; 39(2):112-7. DOI: 10.1016/S0033-3182(98)71357-X. View