Download - Capacity Assessment – the Outline facts
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Capacity Assessment – the facts
Peteris Darzins BMBS PhD FRACP FRCPC Grad Cert Health Prof Ed
Professor of Geriatric Medicine, Monash University, and Director of Geriatric Medicine, Eastern Health
Outline
■ revise concept of capacity
■ stress that assessments seek evidence of incapacity not of capacity
■ (introduce the Six-Step Capacity Assessment Process)
Capacity is: ■ legal construct defined in the negative
– compare to guilt / innocence – do not need to prove innocence – the absence of incapacity is evidence of
capacity ■ presumed to be present
– fundamental legal principle – disprovable proposition
The aim of assessment of decision making capacity is:
■ not to look for evidence of capacity
BUT
■ to look for evidence of incapacity
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Capacity is:
■ domain specific – finances vs health care
■ decision specific – bypass surgery vs flu vaccine
■ time specific – fluctuating capacity
■ (“specific” not “global”)
Evidence of Incapacity – any of:
■ do not know issues ■ do not know possible approaches ■ do not appreciate reasonably foreseeable
consequences ■ decisions based on delusional constructs
■ in the presence of cognitive impairment
Summary
■ revised concept of capacity
■ stressed that assessments seek evidence of incapacity not of capacity
How will you decide, whether your patient has the capacity to decide?