Decision-making capacity and legal competence are terms often used interchangeably in a hospital setting to describe an individual's ability to make consequential decisions regarding themselves, as a manifestation of their autonomy Autonomy Respect for the patient’s right to self-rule. Medical Ethics: Basic Principles. More specifically, however, capacity describes a patient’s ability to make autonomous decisions regarding their care, as determined by a physician, whereas competence is a legal term that describes a person’s ability to participate in legal processes, as determined by a judge.
Last updated: Nov 29, 2021
Decision-making capacity is a patient’s ability to understand a proposed intervention, its benefits, risks, and alternatives, including the option of no treatment, and make autonomous decisions regarding their care.
There are 4 primary components of medical capacity:
|Communication/expression of choice||
The clinician Clinician A physician, nurse practitioner, physician assistant, or another health professional who is directly involved in patient care and has a professional relationship with patients. Clinician–Patient Relationship assesses the 4 elements intuitively through everyday interactions with the patient (e.g., during daily rounds).
The steps below usually take the form of a fluid conversation that doesn’t necessarily follow a strict order. Throughout the conversation, the clinician Clinician A physician, nurse practitioner, physician assistant, or another health professional who is directly involved in patient care and has a professional relationship with patients. Clinician–Patient Relationship should be able to determine if the patient fulfills the 4 elements.
|Fear or discomfort||Expression of fear or discomfort in a clinical setting|
|Neurologic, psychiatric, or developmental conditions||
|Significant cultural or language barriers||Inability to understand the clinical team due to lack of language competency|
Competency, or competence, is a legal term defined as the ability of an individual to participate in legal proceedings, which includes their ability to make medical decisions. Determinations of competence are made by a judge and not by a physician.
The components of competence as determined by a judge are listed below. Note the similarity to the 4 components of medical decision-making capacity.
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