© Springer International Publishing Switzerland 2015
Molly Blackley Jackson, Somnath Mookherjee and Nason P. Hamlin (eds.)The Perioperative Medicine Consult Handbook10.1007/978-3-319-09366-6_3939. Decision-Making Capacity
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Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
Background
Surgeons obtain informed consent from patients for the procedures they perform. Occasionally, however, the medical consultant will be asked to assist with assessment of a particular patient’s capacity (or lack thereof) to consent to evaluation and/or treatment. Patients are presumed to possess decision-making capacity, unless a clinical evaluation suggests that it is lacking [1–3]. Studies suggest, however, that clinicians frequently fail to recognize when patients lack decision-making capacity [1, 3].
Risk Factors for Loss of Decision-Making Capacity
What Risk Factors Suggest That a Patient May Lack Medical Decision-Making Capacity? [2, 3]
Developmental delay
Alzheimer disease and other forms of dementia or cognitive impairment
Psychiatric illness
Residence in a skilled nursing facility (SNF)
Parkinson’s disease
Hospitalization for medical illness
Diagnosis of brain tumor or traumatic brain injury
Note that a significant percentage of patients with these risk factors, including those with psychosis, dementia, or developmental delay, will possess decision-making capacity.
Do Patients with Dementia Always Lack Decision-Making Capacity?
No. Measures of cognitive function such as the mini-mental status examination (MMSE) correlate with decision-making capacity at high scores (indicating that the patient is more likely to have capacity) and low scores (indicating that the patient is less likely to have capacity); however, patients with low scores may still possess decision-making capacity, and patients with high scores may lack it. MMSE scores between 20 and 24 have no effect on the likelihood that the patient has decision-making capacity [1, 3, 4].
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