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Assessing Decision-Making Capacity: A Primer for the Development of Hospital Practice Guidelines

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Abstract

Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the context of DMC assessment before discussing some considerations relevant to policy creation by healthcare ethics committees. The discussion concludes in a presentation of a typology of capacity assessment policies, which draws upon a sampling of currently used hospital policies to illustrate relevant ethical considerations.

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Acknowledgments

The authors acknowledge and thank Paul Appelbaum for initial feedback, the Thomas Scattergood Behavioral Health Foundation for providing support, and Katherine Buckley for her editorial assistance.

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Authors and Affiliations

  1. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Second Floor, Philadelphia, PA, 19104, USA

    Andrew M. Siegel

  2. School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA

    Anna S. Barnwell

  3. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA

    Dominic A. Sisti

Authors
  1. Andrew M. Siegel
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  2. Anna S. Barnwell
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  3. Dominic A. Sisti
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Correspondence to Andrew M. Siegel.

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Siegel, A.M., Barnwell, A.S. & Sisti, D.A. Assessing Decision-Making Capacity: A Primer for the Development of Hospital Practice Guidelines. HEC Forum 26, 159–168 (2014). https://doi.org/10.1007/s10730-014-9234-8

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  • DOI: https://doi.org/10.1007/s10730-014-9234-8

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