What is a capacity evaluation?
A capacity evaluation is commonly done in psychiatry to evaluate the patient’s ability to make a decision on their own. Are they aware of what they are agreeing to? Are they aware of the risks and benefits? Are they aware of the alternative options? Capacity is the ability to provide consent taking into consideration all of the above factors. Many times, a patient is referred to a psychiatrist for a capacity evaluation so the referring physician can have assurance that the patient not only agrees to their treatment plan, but more importantly, the patient has the competency to refuse their treatment plan. Competency is the degree of mental soundness required to make decisions about a specific issue or to carry out a specific act, and is determined via a judicial finding by the court. Capacity is a patient’s ability to make an informed decision, and is determined by a physician.
What are capacity evaluations needed for?
Capacity evaluations may be required before a patient receives medication, undergoes a surgical procedure, or participates in a clinical trial. The physician should ensure the patient understands their medical condition, is aware of exactly what the treatment plan entails, including the risks, benefits, and alternatives, and has the capacity to make a sound decision voluntarily and with no coercion while understanding the consequences of their decision. Capacity evaluations may also be necessary when patients are preparing wills, or assigning a power of attorney to make decisions for them when they no long have the capacity to do so.
How is capacity determined?
There is no single question or specific quick test to determine a patient’s decision making capacity. Instead, capacity evaluations are conducted via clinical interview and mental state evaluations, demonstrating to the physician that the patient possesses the requisite knowledge about the specific issue and demonstrates a reliable and voluntary decision. It is important to note that decision making capacity is a functional evaluation and does not correlate to a patient’s psychiatric diagnosis. A psychiatric diagnosis of a mental disorder does not necessarily render a person incapable of making sound decisions.