Hostname: page-component-55f67697df-xq6d9 Total loading time: 0 Render date: 2025-05-09T01:46:50.414Z Has data issue: false hasContentIssue false
  • English
  • Français

Capacity Reconceptualized: From Assessment Tool to Clinical Intervention

Published online by Cambridge University Press:  24 February 2023

Omar F. Mirza Open the ORCID record for Omar F. Mirza [Opens in a new window]  and
Jacob M. Appel Open the ORCID record for Jacob M. Appel [Opens in a new window]
Omar F. Mirza*
Affiliation:
Department of Psychiatry, Harlem Hospital, New York, New York, USA
Jacob M. Appel
Affiliation:
Department of Psychiatry and Medical Education, Mount Sinai’s Icahn School of Medicine, New York, New York, USA
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Capacity evaluation has become a widely used assessment device in clinical practice to determine whether patients have the cognitive ability to render their own medical decisions. Such evaluations, which might be better thought of as “capacity challenges,” are generally thought of as benign tools used to facilitate care. This paper proposes that such challenges should be reconceptualized as significant medical interventions with their own set of risks, side effects, and potentially deleterious consequences. As a result, a cost–benefit analysis should be implemented prior to imposing such capacity challenges, and efforts should be made to minimize such challenges in situations where they are unlikely to alter the course of treatment.

Keywords

autonomymedical decision-makingdecision-making capacitydecisional capacitypaternalism
Type
Research Article
Information
Cambridge Quarterly of Healthcare Ethics , Volume 33 , Issue 1 , January 2024 , pp. 35 - 39
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Notes

1. Jourdan, JB, Glickman, L. Reasons for requests for evaluation of competency in a municipal general hospital. Psychosomatics 1991;32:413–16CrossRefGoogle Scholar.

2. Brown, PF, Tulloch, AD, Mackenzie, C, Owen, GS, Szmukler, G, Hotopf, M. Assessments of mental capacity in psychiatric inpatients: A retrospective cohort study. BMC Psychiatry 2013;13:115 CrossRefGoogle ScholarPubMed.

3. Appelbaum, PS, Grisso, T. Assessing patients’ capacities to consent to treatment. The New England Journal of Medicine 1988;319(25):1635–8CrossRefGoogle ScholarPubMed.

4. See note 3, Appelbaum, Grisso 1988.

5. Drane, JF. The many faces of competency. Hastings Center Report 1985;15(2):17–21 Google ScholarPubMed.

6. Roth, LH, Meisel, A, Lidz, CW. Tests of competency to consent to treatment. American Journal of Psychiatry 1977;134:279–84Google ScholarPubMed.

7. Buchanan, AE, Brock, DW. Deciding for others: The ethics of surrogate decision-making. New York: Cambridge University Press; 1990 CrossRefGoogle Scholar.

8. McFarland, DC, Blackler, L, Hlubocky, FJ, Saracino, R, Masciale, J, Chin, M. Decisional Capacity Determination in patients with cancer. Oncology 2020;34(6):203–10Google ScholarPubMed.

9. Seyfried, L, Ryan, KA, Kim, SY. Assessment of decision-making capacity: Views and experiences of consultation psychiatrists. Psychosomatics 2013;54(2):115–23CrossRefGoogle ScholarPubMed.

10. Nimmon, L, Stenfors-Hayes, T. The “handling” of power in the physician–patient encounter: Perceptions from experienced physicians. BMC Medical Education 2016;16:114 CrossRefGoogle Scholar.

11. Rice, TR, Dobry, Y, Novakovic, V, Appel, JM. The importance of patient–provider communication in end-of-life care. Bioethical Inquiry 2012:9;439–41.CrossRefGoogle Scholar

12. Joseph-Williams, N, Edwards, A, Elwyn, G. Power imbalance prevents shared decision making. BMJ 2014;348:g3178 CrossRefGoogle ScholarPubMed.

13. Emanuel EJ, Emanuel LL. Four models of the physician–patient relationship. JAMA 1992;267(16):2221–6CrossRefGoogle Scholar.

14. Garrett, WS, Verma, A, Thomas, D, Appel, JM, Mirza, O. Racial disparities in psychiatric decisionalcapacity consultations. Psychiatr Serv. 2023;74(1):10–16 CrossRefGoogle Scholar.

15. Ward, EC, Wiltshire, JC, Detry, MA, Brown, RL. African American men and women’s attitude toward mental illness, perceptions of stigma, and preferred coping behaviors. Nursing Research 2013;62(3):185–94CrossRefGoogle ScholarPubMed.