When assessing a patient’s capacity to consent, which approach is appropriate if mental illness is present?

When assessing a patient’s capacity to consent, which approach is appropriate if mental illness is present?

• A. Use a case-by-case assessment of decision-making capacity; mental illness alone does not decide.
• B. Treat as fully capable unless proven otherwise.
• C. Always require a guardian to decide.
• D. Always assume incapacity.

Answer: (A)

The key idea is that capacity to consent is decision-specific and must be evaluated case by case. Capacity depends on whether the person can understand the information about the decision, appreciate how it applies to their situation, reason about options, and communicate a choice. Mental illness by itself does not automatically determine capacity, so someone with a mental illness may have capacity for some decisions and not others, and capacity can change over time or with treatment or support. The appropriate approach is to assess these abilities for the specific decision at hand rather than making a blanket judgment. If capacity is demonstrated, the person can consent; if not, steps such as simplifying information, providing support, or involving surrogates or guardians may be considered, with guardianship reserved for situations of persistent incapacity. This avoids assuming incapacity or universally granting or denying decision-making authority. So, because capacity is decision-specific and can vary with symptoms and time, a case-by-case assessment is the appropriate path.

The key idea is that capacity to consent is decision-specific and must be evaluated case by case. Capacity depends on whether the person can understand the information about the decision, appreciate how it applies to their situation, reason about options, and communicate a choice. Mental illness by itself does not automatically determine capacity, so someone with a mental illness may have capacity for some decisions and not others, and capacity can change over time or with treatment or support.

The appropriate approach is to assess these abilities for the specific decision at hand rather than making a blanket judgment. If capacity is demonstrated, the person can consent; if not, steps such as simplifying information, providing support, or involving surrogates or guardians may be considered, with guardianship reserved for situations of persistent incapacity. This avoids assuming incapacity or universally granting or denying decision-making authority.

So, because capacity is decision-specific and can vary with symptoms and time, a case-by-case assessment is the appropriate path.