Assessing Medical Decision-Making Capacity in Patients with Behavioral Illness: How do you know?

Speaker for this CME Activity:  Marc Tunzi, MD, MA

Physicians are often faced with the difficulty of assessing medical decision-making capacity in patients with psychiatric illness who are refusing care. Health professionals often assess capacity differently in practice. Provided their patients have some understanding of their illness and have some plans for meeting basic needs, psychiatrists are often inclined to give patients the freedom to refuse care even if they do not exhibit a full understanding of the medical facts of their case and why they are refusing it. Adult medicine physicians, in contrast, are inclined to require patients to state a more complete understanding of the benefits and burdens of evaluation and treatment before allowing them to refuse care when their refusals might result in adverse medical outcomes. This activity will explore the tension between these approaches and highlight the role of hospital ethics consultation in addressing this conflict.

 Desired Outcomes:

• Articulate the differences between capacity and competence.
• Identify the four sub-abilities of medical decision-making capacity.
• Select the best practices when assessing capacity: e.g., consistency with past behaviors vs. the ability “to reason with medical information.”
• Employ strategies to engage the patient’s family and friends, personal primary care physician, behavioral health staff, psychiatric consultation, and ethics consultation in the assessment process.

CME Activity Flyer (PDF)