Author: Nasiya Ahmed, MD, Susan Gorman, MSN, RN, GNP, & Rechelle Asirot, MD
Medical law and ethics presume an adult can make medical decisions about their care.
The burden is placed on the responsible physician to determine whether a patient lacks that ability. This joint process involves the patient and physician, and may include advocacy and communication from others.
Executive function is a cognitive ability that involves the planning and execution of goal-directed behaviors, abstract reasoning, and judgment.
Executive function involves decisional capacity beyond medical decision making. The patient must be able to successfully practice self-care and self-protective functions such as activities of daily living (ADL's) and independent activities of daily living (IADL's). ADL's include bathing, grooming, toileting, and eating. IADL's include taking medications appropriately, food preparation, making and keeping medical appointments, fulfilling financial responsibilities and bill paying.
To establish competence, the patient must:
Try using this easy mnemonic, U R Definitely Capable to remember.
Assessment Tools available for your use in the clinical setting:
Applebaum, P.S. & Grisso, T. (1988). Assessing Patients' Capacities to Consent to Treatment. New England Journal of Medicine; 319:1635-1638.
Beauchamp, T.L. & Childress, J.F., (Eds.) (2008). Principles of biomedical ethics. New York, NY: Oxford University Press.
Ganzini, L., Volicer, L., Nelson, W. A., Fox, E., & Derse, A.R. (2004). Ten Myths about Decision-Making Capacity. Journal of the American Medical Directors Association; 5(4):263-267.DOI: 10.1097/01.JAM.0000129821.34622.A2
Grisso, T., Appelbaum, P.S., & Hill-Fotouhi, C. (1997). The MacCAT-T: A clinical tool to assess patients' capacities to make treatment decisions. Psychiatric Services; 48:1415–1419. Lai, J.M. & Karlawish, J.H. (2006). Assessing the capacity to make everyday decisions. American Journal of Geriatric Psychiatry; 15:101–111.
Naik, A.D., Lai, J.M., Kunik, M.E., & Dyer, C.B. (2008). Assessing capacity in suspected cases of self- neglect. Geriatrics; 63:24–31.