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Assessing the Competence Assessment Tool

The Capacity Assessment Tool (CAT) proposed by Maria Carney and colleagues is a distinct improvement over many such tools that have been proposed, but it still faces a number of practical and theoretical challenges. In fact, these challenges are daunting enough to call into question all projects of this sort. The CAT is designed to allow primary care physicians to evaluate a patient’s capacity to make a particular healthcare decision. Designed to address the legal standards identified by Appelbaum and Grisso, the CAT involves discussing with patients the decision at issue and assigning patients points based on their performance in the following six areas: (1) ability to communicate, (2) ability to understand the available alternatives, (3) ability to comprehend risks and benefits, (4) ability to show insight into the reasoning behind their decisions, (5) ability to describe factors that influenced these decisions, and (6) ability to foresee and plan for problems with their chosen course of action. Patients whose scores meet minimum requirements are declared capable of making the decision under consideration (although they may be incapable of making other decisions about their healthcare).