BIOETHICS FOR CLINICIAN .3. CAPACITY

In the context of patient consent, ''capacity'' refers to the patient' s ability to understand information relevant to a treatment decision a nd to appreciate the reasonably foreseeable consequences of a decision of lack of decision. A person may be ''capable'' with respect to one decision but not with respect to another. Clinicians can usually ident ify patients who are clearly capable or incapable, but in some cases a clinical capacity assessment is required. Such assessment may consist of cognitive status testing, general impressions of capacity of speci fic capacity assessment. Specific capacity assessment, in which the cl inician evaluates the patient's ability to understand pertinent inform ation and appreciate its implications, is probably the optimal method. When conducting a specific capacity assessment, the clinician must en sure that the disclosure of information is effective and must evaluate the patient's reason for his or her decision. If the assessment sugge sts that the patients is incapable, further assessment is generally re commended.