Decisional Capacity Assessments and Advance Directives

Assessing the mental capacity of psychiatric patients to make decisions is a challenging task for on-call psychiatric consultants who may not be familiar with the patients. Patients are presumed to have the cognitive capacity to make choices regarding their treatment, finances, and personal care. At times, they may not fully understand or appreciate the risks, benefits, and consequences involved. Physicians may necessarily be required to rely on information from family members, medical assessments, and the patients’ medical history to make clinical judgments about decisional capacity. Advance directives are legal documents that allow patients who may become mentally incapable to execute their prior competent wishes and often appoint legally authorized representatives to express those wishes. This chapter examines some of the common pitfalls and offers tips that can assist on-call clinicians as they perform capacity assessments.