Assessing How We Assess Decision-Making Capacity: Informed Consent Is Necessary Before Each Capacity Assessment​

Abstract

Decision-making capacity assessments (DMCA) often are made in the setting of a hospitalized patient with questionable mental status. Professional organizations have established that typically, for a patient to be considered to have decision-making capacity, they must demonstrate the following four criteria with respect to their medical condition: 1) ability to express a choice, 2) understanding, 3) appreciation and 4) rational thought. Often a psychiatry consultation is requested for such DMCA, during which patients are not made explicitly aware as to the purpose and consequences of the upcoming interview. Informed consent is present in much of medicine; however, there are no explicit rules to notify a patient of a DMCA before one is made. In addition to the four already established principles in DMCA, we propose one additional rule: interviews must begin with informing the patient as to the nature of the upcoming interaction and inform the patient of their right of refusal related to the assessment.