Medical Decision-Making Capacity of Patients With Dementia

[...] the court in Natanson v Kline established that the clinician should provide information that the "reasonable medical practitioner" would customarily disclose to a patient.4 Later, in Canterbury v Spence, a court shifted its position and ruled that the doctor should provide information that a "reasonable person" would want to know in order to decide whether to accept or refuse the proposed treatment.5 This shift from what the reasonable practitioner would discuss to what the reasonable person would want to know directed the clinician to consider knowledge of the patient's specific circumstances and mental state. The clinician should be satisfied that the patient is making a voluntary decision without being coerced.19 When it is not clear whether the patient has the capacity to consent, or when future litigation is likely, structured assessment instruments, such as the MacArthur Competence Assessment Tool, can be used.20,21 However, the clinical interview remains the gold standard in assessing patient's capacity.22,23 (Please refer to Eth and Leong19 for a more in-depth discussion of obtaining voluntary informed consent.) Capacity is not static Decision-making capacity must be evaluated for each medical decision, because it is neither static nor broadbased.