Decisional Capacity
What is Decisional Capacity?
Decisional capacity refers to a person’s ability to understand, consider, and make informed choices about their medical care. In palliative settings, this often relates to decisions about treatments, procedures, or comfort-focused care when facing serious illness.
Key Elements of Decisional Capacity
To ensure a person can make a quality healthcare decision, several criteria must be met:
Awareness of Choice
The individual must know that a decision needs to be made and understand that there are different options available.
Ability to Communicate the Choice
The person should be able to express their choice clearly—either verbally or through consistent, meaningful communication.
Consistency and Commitment
A quality decision should be consistent over time, not changing frequently or unpredictably. The individual should demonstrate commitment to their expressed choice.
Understanding the Relevant Information
The individual must grasp the facts of their condition—such as having heart failure, cancer, or being in intensive care—and how these affect their options.
Appreciation of the Consequences
They must understand the benefits and burdens of each option. For example: “If I choose this treatment, I might live longer but with more discomfort. If I choose comfort care, I may live a shorter time but with less pain.”
Rational Processing of Information
The person should be able to weigh the potential outcomes, compare options, and apply this reasoning to reach a decision that aligns with their values and goals.
When Decisional Capacity Is Unclear
In some cases—especially in intensive care or advanced illness—a person may be too ill, sedated, or cognitively impaired to fully engage in complex decision-making. In such situations, families and healthcare teams may look for signs like blinking or hand-squeezing in an effort to communicate. However, these are not substitutes for meaningful, informed decisions.
If a patient lacks decisional capacity, a designated healthcare proxy or legal decision-maker may need to step in to make choices in their best interest or according to known wishes.
Supporting Families and Caregivers
Understanding whether a loved one has the ability to make medical decisions can be emotional and confusing. Our care team is here to help you navigate this process with compassion and clarity.
Need help evaluating decisional capacity or understanding your loved one’s choices?