Involuntary Psychiatric Admission and Medical Decision-Making Capacity

Understanding Medical Capacity and Psychiatric Commitment Criteria

Lack of medical capacity means a patient cannot understand, retain, use, or weigh information to make a specific medical decision due to impairment of mind or brain function, as noted by the American Society of Anesthesiologists 1, 2, 3
The American College of Gastroenterology guidelines state that medical capacity is issue-specific, and a patient may have capacity to consent to simple procedures but not complex ones 2, 3
The American Medical Association recommends that patients who lack capacity for medical decisions should have treatment decisions made based on best interests, considering medical factors, social factors, psychological factors, and what the patient's attitude would likely be 4, 7

The American Psychiatric Association suggests that a patient's mental illness alone does not automatically mean incapacity, and even patients detained under mental health legislation should not be assumed incapable of providing valid consent for medical, surgical, or dental treatment 4, 6
The American College of Emergency Physicians guidelines state that civil commitment permits detention for psychiatric evaluation and treatment of mental illness, but does not permit detention for medical illnesses or involuntary administration of medical treatments 3
The National Institute of Mental Health recommends that psychiatrists should assess for psychiatric emergency criteria, including the presence of mental illness and danger to self or others, before issuing an involuntary psychiatric hold 3, 4

The Joint Commission recommends that healthcare providers clearly document the grounds for determining lack of capacity, the treatment that will be undertaken, and how this treatment serves the patient's best interests 4, 7
The American Health Information Management Association suggests that documentation should include attempts to consult family or others if time permits, and should distinguish between capacity for psychiatric treatment and capacity for surgical or medical consent 4