From the Guidelines
A patient is considered incapacitated when they lack the ability to make informed decisions about their own healthcare or personal affairs, as defined by their inability to understand, remember, use or weigh up relevant information, or communicate their decisions effectively, as stated in the guideline for obtaining valid consent for gastrointestinal endoscopy procedures 1. This means they cannot comprehend relevant information about their medical condition, treatment options, or potential consequences, and cannot express their choices effectively. Incapacitation may result from various causes including unconsciousness, severe cognitive impairment, mental illness, developmental disabilities, dementia, stroke, traumatic brain injury, or being under the influence of certain medications or substances. When a patient is incapacitated, healthcare decisions typically fall to a designated healthcare proxy, power of attorney, legal guardian, or next of kin according to state laws. The determination of incapacity is usually made by physicians through clinical assessment of the patient's decision-making abilities, considering factors such as the patient's ability to understand, remember, and use or weigh up relevant information, as well as their ability to communicate their decisions effectively, as outlined in the American Journal of Respiratory and Critical Care Medicine 1. Some key points to consider include:
- Capacity is decision-specific and may fluctuate over time, as noted in the American Journal of Respiratory and Critical Care Medicine 1
- Loss of decisional capacity may be transient, and reversible causes of impaired capacity should be addressed when feasible, as recommended in the American Journal of Respiratory and Critical Care Medicine 1
- Patients with mental illness should not be assumed to be incapable of providing valid consent for medical, surgical, or dental treatment, unless their capacity has been assessed and found to be lacking, as stated in the Anaesthesia journal 1
- Refusal of treatment by an adult with capacity is legally binding, even if refusal is likely to result in the patient’s death, as noted in the Anaesthesia journal 1 Healthcare providers must document their assessment of capacity and the reasons for determining a patient lacks decision-making capacity to ensure proper protocols are followed for substitute decision-making, as emphasized in the guideline for obtaining valid consent for gastrointestinal endoscopy procedures 1.
From the Research
Definition of Incapacitation
- Incapacity refers to the clinical state in which a patient is unable to participate in a meaningful way in medical decisions 2.
- A patient is considered incapacitated when they are unable to describe the physician's view of the situation and understand the physician's opinion as to the best intervention 2.
Characteristics of Incapacitated Patients
- Incapacitated patients may be comatose, mentally retarded, mentally ill, or physically handicapped 2.
- They may also be previously capable patients who become transiently incapacitated during the course of hospitalization 2.
- Incapacitated patients require a surrogate decision-maker to make medical decisions on their behalf 2, 3.
Decision-Making for Incapacitated Patients
- When a patient is deemed to be incapacitated, the physician should turn to family members, whenever possible, to make decisions 2.
- Clinicians and family members must make critical medical decisions without input from the patient when there is no advance directive 3.
- Respecting autonomy is of paramount importance when considering withdrawing treatment, while decision-making about continuing life-sustaining treatment requires clinicians to ensure surrogates are adequately educated about the principle of beneficence 3.