Abstract
Adequate cognitive and emotional capacity is essential to autonomous decision making by adult medical patients. Society often attaches legal consequences to decisional capacity evaluations. Even when the legal system is not formally involved in the competency evaluation of a particular individual, clinical practice and ethical conduct occur within and are informed by legal parameters. Using relevant statutory, court rule, and judicial opinion examples from a representative jurisdiction within the United States, this article argues that the law seldom provides much meaningful guidance to health care and human services providers to assist them regarding the content of capacity evaluation. The article concludes by asking how society ought to respond to the paucity of helpful guidance provided by the law in the decisional capacity evaluation context.
Highlights
IntroductionAdequate cognitive and emotional capacity—as well as sufficient voluntariness and access to material information—are essential elements for the exercise of autonomous decision making, including making choices about the acceptance of specific health care and human services, by older adults
Adequate cognitive and emotional capacity—as well as sufficient voluntariness and access to material information—are essential elements for the exercise of autonomous decision making, including making choices about the acceptance of specific health care and human services, by older adults.Of necessity, health care and human services professionals have incrementally developed a set of general working criteria for evaluating decisional capacity that balances considerations of individual autonomy with the complementary or competing ethical principles of beneficence, nonmaleficence, and respect for persons.Application of these working criteria of decisional capacity to specific cases is an inherently interdisciplinary endeavor
Health care and human services professionals have incrementally developed a set of general working criteria for evaluating decisional capacity that balances considerations of individual autonomy with the complementary or competing ethical principles of beneficence, nonmaleficence, and respect for persons
Summary
Adequate cognitive and emotional capacity—as well as sufficient voluntariness and access to material information—are essential elements for the exercise of autonomous decision making, including making choices about the acceptance of specific health care and human services, by older adults. Health care and human services professionals have incrementally developed a set of general working criteria for evaluating decisional capacity that balances considerations of individual autonomy with the complementary or competing ethical principles of beneficence (doing good), nonmaleficence (preventing harm), and respect for persons. Application of these working criteria of decisional capacity to specific cases is an inherently interdisciplinary endeavor. Using relevant Florida statutes, court rules, and judicial opinions as examples that are representative of state law nationally, this article suggests that the civil law seldom provides much meaningful guidance to health care and human services professionals to assist them regarding the content of a capacity evaluation. The article concludes by asking how society ought to respond to the arguable paucity of helpful guidance provided by the law in the decisional capacity evaluation context
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