Page header image

Decisional Capacity

What is decisional capacity?

Decisional capacity is the ability to make decisions. When you are able to make your own decisions you can:

  • Understand what is happening around you
  • Make decisions based on your own values
  • Understand what the possible results of your decisions might be
  • Communicate your decisions in some way, such as by speaking, writing, blinking your eyes, or using Braille, gestures, picture boards, or computers

If for some reason you lose your ability to make decisions for yourself, you will need to have others make important decisions for you. Some decisions can be very hard for someone else to make. While you are still able, you may want to talk to your family about your wishes and values. This will help you and your family if you are unable to make decisions yourself.

What affects the ability to make a decision?

Things that may for a time affect your ability to make decisions include:

  • Severe anxiety, depression, or other mental illness
  • Side effects of some medicines
  • A serious illness such a a heart attack, kidney failure, or liver failure

Your decisional capacity may get better as you recover from an illness or medicine side effects wear off.

Some health problems may affect your decisional capacity for the remainder of your life, such as:

  • Dementia, which is a gradual loss of the ability to think, remember, reason, and plan
  • Brain injury from a stroke or accident

When is it a problem?

Questions about your ability to make decisions may come up when:

  • You have been injured and need to give consent for surgery or other treatments while in the hospital.
  • You have a worsening health problem and need to give consent for treatments.
  • You are suddenly very ill and need to give consent for treatments.
  • You are in a coma or don’t respond to questions.
  • Your release from the hospital is being planned.

How is it checked?

There is no one certain way to check decisional capacity. Your healthcare provider may ask you to talk about a decision you have made. Your provider checks to see how much you understand about what might happen with your choice and what your other options are.

For healthcare decisions, your healthcare provider will usually ask questions to see if:

  • You understand your situation.
  • You can explain the reasons for your choices.
  • You can describe the risks and benefits of your choices.

Your healthcare provider will compare your present and past behavior and choices. The focus is on how you make decisions and not whether other people agree with your decisions. Your healthcare provider will also consider information provided by relatives and other providers.

Is decisional capacity the same as competence?

Decisional capacity and competence are similar. You, your family, and your healthcare provider determine your ability to make decisions about your life, including your health. There may be some decisions you cannot make and others you can.

A court of law judges competence. All adults are assumed to be "of sound mind" unless the court declares them incompetent. Unlike decisional capacity, competence is usually all or nothing. If the court declares you incompetent, the court appoints a guardian to act on your behalf. The court can limit the guardian’s authority to (for example) just healthcare decisions.

Courts review competency cases only if someone asks for the review. Usually it’s a family member or caregiver who makes the request.

What can I do to help myself?

The more you can plan ahead, the less you leave your life to chance and the courts. There are legal documents that you can create and sign while you are of sound mind and able to make decisions for yourself. You don’t have to be ill to complete these. They include:

  • A durable power of attorney (DPOA) for business, property, and financial decisions
  • A durable power of attorney for healthcare decisions (DPOA-HC). The DPOA-HC goes into effect if you are unconscious or unable to make decisions.
  • A living will (also called an advance directive), which tells family and healthcare providers what type of medical treatment you do and do not want if you cannot make decisions for yourself. For example, you can specify whether you want to be kept alive on a breathing machine or be fed through a tube.

In these documents, you appoint a person to make decisions on your behalf if you are unable to do so. The person named in the DPOA does not have to be the same person named in the DPOA-HC. Make sure that you talk to the person you name as DPOA so that they know what you want them to do. These documents apply only during the time that you cannot make decisions for yourself.

Developed by RelayHealth.
Adult Advisor 2015.1 published by RelayHealth.
Last modified: 2014-06-25
Last reviewed: 2014-06-24
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2015 McKesson Corporation and/or one of its subsidiaries. All rights reserved.
Page footer image