Jack's Capacity
Assessing Jack’s capacity
Who can undertake capacity assessments?
(please select all that apply)
Who can undertake capacity assessments?
Which of the following should be used to assess Jack’s capacity?
Cognitive screening tool
Although cognitive functioning correlates with aspects of decision-making capacity, cognitive screening tools lack sensitivity and specificity in determining a person’s decision-making capacity (Lamont, Jeon, & Chiarella, 2013) – Explore another option.
Framework which identifies the risks associated with Jack’s decision
In NSW, every adult with decision-making capacity has the legal right to refuse recommended healthcare treatments in spite of the risks associated with the decision. As Lord Donaldson famously stated in a seminal UK case, which set a common law precedent (Re T (Adult refusal of medical treatment) [1992] 4 All ER 649):
“the patient’s right of choice exists whether the reasons for making that choice are rational, irrational, unknown or even non-existent. That his choice is contrary to what is to be expected of the vast majority of adults is only relevant if there are other reasons for doubting his capacity to decide” [at 662]
Therefore, the risks alone associated with Jack not having treatment, are not sufficient making a determination of his decision-making capacity – Explore another option.
Structured professional judgement
In NSW, a person lacks capacity if the person (Hunter and New England Area Health Service v A [2009] NSWSC 761):
- is unable to comprehend and retain the information which is material to the decision, in particular as to the consequences of the decision; or
- is unable to use and weigh the information as part of the process of making the decision
Therefore, a structured conversation and professional judgement in relation to the above criteria would be the best option for determining Jack’s decision-making capacity – Explore another option.
Capacity assessment instrument
Despite a plethora of capacity assessment instruments being available, limitations exist in each (Lamont, Jeon, & Chiarella, 2013). A strictly formulaic approach to the assessment of capacity is unlikely to capture specific individual nuances and values relevant to an individual’s decision-making capacity – Explore another option.
Assessing Jack’s decision-making capacity
View more of Jack’s story below as his treatment continues.
immediate medical issue of likely dehydration...
Jack’s organ function...
concerned about his health,...
hospital or recall the proposed treatment, stating:
immediate medical issue of likely dehydration...
Jack’s organ function...
concerned about his health,...
hospital or recall the proposed treatment, stating:
In the meantime you have taken time to talk to Jack and explain the most immediate medical issue of likely dehydration and the proposed plan for rehydration. You also discussed the importance of a routine blood test to determine Jack’s organ function and explained the likely consequences of untreated dehydration.
When asked if Jack understood why Coral and the hospital staff were concerned about his health, Jack was unable to re-state in his own words why he had been brought to hospital or recall the proposed treatment, stating “I don’t know, I’ll be fine if I’m just left alone, I just want to go home”.
Now let’s determine Jack’s decision-making capacity using the criteria set out in Hunter and New England Area Health Service v A [2009] NSWSC 761
Please rate Jack’s comprehension and retention of diagnostic and treatment information, in particular as to the consequences of the decision.
(1=very poor, 10= very good)
Please rate Jack’s ability to use and weigh the information as part of the process of making the decision.
(1=very poor, 10= very good)
Capacity
Based upon your scoring using the above criteria; do you think Jack has decision-making capacity?
CORRECT
Jack evidently lacks comprehension and retention of diagnostic and treatment information, and the likely consequences of not having treatment. Further, he is unable to use and weigh the information and concerns presented to him, when making the decision that he’ll be fine, and wants to go home. Therefore, Jack lacks decision-making capacity for this specific healthcare decision.
Situation-specific decision making capacity
Several terms are used interchangeably within the health and legal literature to reflect a person’s ability to make decisions about their wellbeing, despite not being synonymous. See for example ‘capacity’, ‘mental capacity’, ‘competence’, and ‘legal capacity’. Technically, a person’s competence or legal capacity is reserved to judgments determined in court, which may be influenced by an assessment of capacity as determined by a health practitioner. Further, capacity outcomes generally differ from legal outcomes as they are reserved for decision-making about a specific healthcare decision, not all aspects of a person’s decision-making.
INCORRECT
Jack evidently lacks comprehension and retention of diagnostic and treatment information, and the likely consequences of not having treatment. Further, he is unable to use and weigh the information and concerns presented to him, when making the decision that he’ll be fine, and wants to go home. Therefore, Jack lacks decision-making capacity for this specific healthcare decision.
Situation-specific decision making
Several terms are used interchangeably within the health and legal literature to reflect a person’s ability to make decisions about their wellbeing, despite not being synonomous. See for example ‘capacity’, ‘mental capacity’, ‘competence’, and ‘legal capacity’. Technically a person’s competence or legal capacity is reserved to judgments determined in court, which may be influenced by an assessment of capacity as determined by a health practitioner. Further, capacity outcomes generally differ from legal outcomes as they are reserved for decision-making about a specific healthcare decision, not all aspects of a person’s decision-making.