fundamentals
Capacity to Make Health Care Decisions
Clinical incapacity
Clinical incapacity to make health care decisions is the medical judgment of a qualified doctor or other health care professional who determines a person is unable to do the following: Understand his or her medical condition or the significant benefits and harms of proposed treatment and its alternatives Make or communicate appropriate medical decisions Like legal capacity, clinical capacity is specific to a particular health care decision and is limited to that decision. A person may have the clinical capacity to make a basic health care decision (for example, receiving IV fluids) but may not be able to decide whether to participate in a clinical trial. Importantly, a person with some decrease in capacity may still have enough capacity to designate a Default Surrogate Decision Making . Also, clinical incapacity is not necessarily permanent. People who are intoxicated, delirious, comatose, severely depressed, agitated, or otherwise impaired are likely to lack the capacity to make health care decisions but may later regain that capacity. A person’s ability to carry out a decision is also important for doctors to assess. For example, a person with a broken leg may be able to make decisions (for example, to leave the hospital and manage at home) but be unable to carry them out. Providing the necessary support to carry out a decision becomes an important goal of care. People with dementia may require an evaluation of their level of cognition, memory, and judgment before their doctors can proceed with medical care. People with mild dementia may think clearly enough to understand discussions with their doctors and make some medical decisions. A doctor cannot go against a person’s wishes unless a court declares the person legally incapacitated or the person's wishes are medically or ethically inappropriate. If doctors find that a person lacks clinical capacity, they turn to someone with the legal authority to act as substitute decision maker. However, if the person or other appropriate party objects to a particular medical decision or to the determination of clinical incapacity, the courts may become involved. In an emergency, people are presumed to consent to any necessary emergency treatment. This process of making emergency health care decisions for people who cannot make decisions for themselves is rarely litigated in court. 