personal decisions

3C’s of decision-making: capacity, capability, consent

If you think that saying yes – meaning giving consent– to a treatment or therapy or option would be as easy as saying ‘yes’, you’re wrong. Equally true for a ‘no’

Before your yes (or no) is considered acceptable, you have to be of ‘sound enough mind’ that you understand what’s being offered, and understand the consequences of the offer.

If it sounds complicated, it’s because we humans are complicated. Bioethicist and Lawyer, Elizabeth Sloss explains:

“Often, patients don’t lose their capacity  – their ability to make decisions – all at once. Very often a patient will move from capable to incapable of decision-making even over the course of a day.

For example, where a patient’s pain becomes unmanageable it may not be possible to understand the possible consequences of a particular treatment option; however, if the patient is given adequate pain medication, they may be more able – have more capacity to make a decision.. 

Patients with Dementia are sometimes incapable for long periods but then have clear periods of being ‘completely there’ – when they’d be fully capable of deciding for themselves even sometimes complex treatment options.

“It is also important to recognize that different types of decision require a different level of ‘capacity.’ So, for example, a confused patient may be able to understand that removing a painful toenail would take away pain, but not understand that – with failing kidneys – she’ll have to decide about Dialysis.”

This is from the College of Physicians and Surgeons – the regulatory organization whose mandate is public protection:

  • Does the person understand the condition for which the specific treatment is being proposed?
  • Is the person able to explain the nature of the treatment and understand relevant information?
  • Is the person aware of the possible outcomes of treatment, alternatives or lack of treatment?
    (do you really understand what can happen?‘)
  • Are the person’s expectations realistic?
  • Is the person able to make decision and communicate a choice?
  • Is the person able to manipulate the information rationally? (can you figure out what to do with the information, so it makes sense to you)

When completing your planning tool such as  Advance Directives BestEndings, one of the requirements is to confirm you’re of sound mind.