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What is decision making capacity? 

Sometimes, due to the result of mental or physical illness, disability, or intellectual impairment, there may be questions raised as to whether an individual can ethically and legally be considered capable of making their own decisions. Some examples of common decisional capacities include the ability to consent to medical care, the capacity to live independently, testamentary capacity (the capacity to make a will), and the capacity to drive. One of the roles a neuropsychologist can perform is the evaluation of an individual’s ability to make their own decisions when they are experiencing some type of mental impairment.

Medical Consultation

What is involved in this type of evaluation?

When there is reason to suspect that an individual may lack adequate judgment to make their own decisions, they may be referred to have their current cognitive functioning evaluated. Initially, the neuropsychologist will clarify the referral question, or the specific capacity of concern. They will then obtain relevant information about things such as the underlying health or medical condition, collateral reports about day-to-day functioning, and additional information specific to the types of decisions an individual is being asked to make. This is typically followed by a clinical interview with the individual and sometimes neuropsychological testing. Once all this information has been obtained, a report summarizing the findings and recommendations is then provided.

What determines if someone has the capacity to make their own decisions?

The essential elements of decisional capacity include the following four components:

  • Ability to consistently express a choice/opinion

  • An accurate appreciation of their current medical situation/financial status/living situation.

  • An accurate understanding of the relevant facts about their health/finances/living situation.

  • Ability to demonstrate clear reasoning and provide rational explanations for decisions.

All of these factors are considered in relationship to the relative risk of the decision an individual is making. For example, the capacity to consent to a low-risk medical procedure would have a lower threshold for retaining that ability, than say the capacity to consent to a major/high risk medical procedure. Similarly, adding one’s family member to be able to access a checking account carries much different risks than entering into a legal contract, or assigning a power of attorney. Thus, more complex and high risk decisions require a greater level of appreciation, understanding, and reasoning.

What role does neuropsychological testing play in determining capacity?

Appreciation, understanding, and reasoning can sometimes be difficult to assess based solely on a discussion with an individual as each are made up of numerous cognitive factors. Standardized cognitive tests that measure things such as attention, memory, abstract reasoning, and problem solving, provide useful information about an individual’s relative level of function or impairment. For example, reasoning about medical treatment and appreciating the personal consequences of a treatment decision are complex consent abilities that requires both memory/factual retention of information as well as executive and reasoning skills. Understanding treatment is probably among the most complex and clinically relevant consent ability.

If you or someone you know has concerns about the ability to make decisions or carry out tasks independently, feel free to reach out to us for more information about capacity evaluations. We offer free 15 minute phone consultations or can schedule you for an intake appointment to get the process started

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