Geriatric Quick Consult      Decision-making Capacity      Do #1

Assess the patient's ability to make informed decisions.

Knowledge	Action
Medical ethics, U.S., and Virginia legal codes strongly favor individual freedom of choice regarding any sort of risky procedure. The first step is always to determine whether the individual is able to give consent, also called decisional capacity. Giving consent requires several elements. These include that the patient/caregiver: Understand the nature of the procedure Understand reason(s) for doing procedure, or consequences of not doing it Understand the consequences of doing the procedure Understand the risks involved in the procedure Be informed of alternative management, if any Be able to express an opinion Be able to demonstrate a reasoning process in making the choice	Determine decisional capacity
Before asking and accepting consent, you must ascertain to a reasonable degree of certainty that the individual is able to perform these cognitive tasks. If there is any doubt, the patient should be tested for evidence of adequate thought and communication capabilities. Testing can be done by anyone that is trained to conduct this type of evaluation; often psychiatry performs this service, but psychiatric consultation is not required.	Test thought and communication
To evaluate decision-making capacity you must first conduct a mental status examination, specifically testing basic thinking processes, and communication functions needed for medical decision-making, such as attention, memory, reasoning, reality orientation, and language. The level of cognitive functioning is then considered in relation to the elements of the decision-making process, listed above. To verify decisional capacity, ask the patient to state the nature of the procedure, the reasons for the procedure, the alternatives, and the risks back to you I their own words.	Mental status exam attention memory reasoning reality orientation language