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Capacity assessment is the clinical evaluation of a patient's ability to make informed decisions about their medical care, financial affairs, or other important life matters. It involves determining whether an individual has the cognitive and psychological abilities to understand information, appreciate consequences, reason through options, and communicate a consistent choice.
Capacity can be impaired by various conditions affecting cognitive function, including dementia, delirium, severe mental illness, intellectual disabilities, or acute medical conditions affecting brain function. The assessment focuses on four key domains: understanding relevant information, appreciating the significance of that information for one's own situation, reasoning through treatment options, and expressing a choice consistently.
Clinicians must distinguish between capacity (a clinical determination) and competency (a legal determination), recognizing that capacity can fluctuate and is decision-specific rather than global. The assessment should be conducted when patients are at their optimal cognitive state, using standardized tools when appropriate, and considering whether capacity deficits might be temporary and treatable before making determinations about substitute decision-making.