1. Decision Making Capacity Gary J. Gala, MD

2. Capacity Competency Clinical judgment Clinical judgment Can be assessed by any physician Can be assessed by any physician Usually question- specific, time-specific, short-term Usually question- specific, time-specific, short-term Surrogate decision- makers, if necessary Surrogate decision- makers, if necessary Legal concept Legal concept Can only be adjudicated by a court Can only be adjudicated by a court Usually more global, long-term Usually more global, long-term Designated decision- makers Designated decision- makers

3. Understands and Appreciates Nature of their disorder Nature of their disorder Treatment being offered Treatment being offered Consequences of their Decision Consequences of their Decision

4. The Problem of Rationality What is it? What is it? The process rather than the conclusion The process rather than the conclusion But hard to separate from content But hard to separate from content The issue of values The issue of values

5. Consistency Same over time Same over time Not a flip flopper Not a flip flopper

6. Conceptualizing Capacity Patients Decision Patients Decision Risk/Benefit Ratio Risk/Benefit RatioConsentRefuse Favorable Low threshold for capacity High threshold for capacity Unfavorable Low threshold for capacity

7. Does not Demonstrate Laws assumes competency Laws assumes competency Depends on the risk Depends on the risk

8. Youre gonna need Surrogates or Guardians