Praxis Medical Insights

Patient Capacity

Patients should be presumed to have capacity until proven otherwise through specific assessment, and capacity assessment should not be based solely on age, appearance, or diagnosis, according to the American Society of Anesthesiologists 3, 4
Patients must demonstrate the ability to understand relevant information about their medical condition and proposed treatment, appreciate the significance of this information, reason about treatment options, and express a choice, as recommended by the American Medical Association 1, 2
Decision-specific capacity is the modern approach, recognizing that patients may retain ability to make simpler decisions while lacking capacity for more complex ones, as stated by the American College of Physicians 1, 4
Pain, illness, and premedication do not necessarily render a patient incapable of providing consent, according to the American Society of Anesthesiologists 2

Disclosure should include the nature and purpose of proposed procedures/treatments, significant, foreseeable risks and benefits, available alternative treatments and their risks/benefits, and the option of no treatment and its consequences, as recommended by the American Medical Association 1, 2, 3, 5
The standard for disclosure has shifted from the "reasonable physician" standard to the "reasonable patient" standard, requiring disclosure of all "material risks", according to the American Society of Anesthesiologists 1, 3
Material risks are defined as those a reasonable person would likely consider significant or that the doctor should reasonably be aware would be significant to the particular patient, as stated by the American College of Surgeons 3
Information should be provided in a manner and language the patient can understand, with translators available when needed, and sufficient time must be allowed for patients to process information and ask questions, as recommended by the American Academy of Family Physicians 5

Consent must be given voluntarily by the patient, free from coercion, and patients have the right to accept or refuse recommended healthcare, according to the American College of Emergency Physicians 2, 6
Patients may change their minds and withdraw consent at any time if they still have capacity, as stated by the American Society of Anesthesiologists 2
The decision does not need to be rational or sensible from the clinician's perspective, according to the American Medical Association 3
Family members should not be relied upon to translate for consent discussions, as this may introduce coercive influence, as recommended by the American Academy of Family Physicians 5

Emergency situations where immediate intervention is necessary to prevent death or serious harm are exceptions to obtaining informed consent, according to the American College of Emergency Physicians 6
When a patient explicitly states they do not want to know about risks, though basic information should still be provided, is an exception to informed consent, as stated by the American Society of Anesthesiologists 3, 5
When disclosure would pose a serious threat to the patient's health, beyond merely causing distress, is an exception to informed consent, according to the American College of Surgeons 3
In circumstances of necessity where urgent treatment is needed but the patient lacks capacity, is an exception to informed consent, as recommended by the American Medical Association 3