(Hadyn Till Assessing Capacity 14.9MB)

Health Professionals do not usually witness Advanced Care Directives. That is best done by the person responsible. In the case of conflict it is up to the courts to decide if a person was competent at the time of preparing a certain document. Enduring Guardianship and Enduring Power of Attorney, must be witnessed by a lawyer or officer of the court. So in general the issue of capacity assessment does not directly present to the General Practitioner.

However it is important that the General Practitioner understands the concepts involved in capacity, so that they can explain them to the patient and their family. The General Practitioner also needs to be able to decide when the patient can no longer consent to treatment. The General Practitioner may also on rare occasions be called as an expert witness to the court.

Capacity is not an all or nothing concept. It is possible to have capacity intact in some domains (eg; the capacity to consent to medical treatment), while lacking capacity in other domains (eg; the capacity to manage finances).

Capacity can be lost and regained. With illnesses such as dementia, there may be periods when the patient is more lucid than others.

Under the law the patient is assumed to have capacity, unless there is evidence to the contrary.

The core of a capacity assessment involves confirming that the patient:

• understands the question.

• understands all the options including the option to do nothing.

• understands the reasonably foreseeable consequences of each of these options.

• and has not made their decision based on delusional thinking.

  The patient should be able to respond to each of these questions in their own words. The health professionals should not rely on yes or no responses, but rather have the patient explain the options to them in their own words.

The core of the capacity assessment can only work if the patient has had adequate education around the issues; communication problems have been taken into account; and the patient has  consented for the capacity assessment to take place.

For important questions or for questions that the GP suspects may be disputed, it is prudent to document the capacity assessment in detail. A capacity assessment checklist can help in documenting a thorough capacity assessment.

Capacity Checklist

Conditions of use