You'll be asked a lot to assess a patients capacity. The key things to remember are that capacity is decision and time specific. We should always start any assessment presuming they have capacity until there is evidence to the contrary.
A patient who has capacity to consent for something like a cannula right now may not have the capacity to consent in several hours time if they develop a cognitive issue. This can be transient eg infective processes or progressive eg cognitive disorders like dementia.
In order to have capacity a person must be able to understand, weigh up risks and benefits to make a decision using the information provided, retain information and communicate it back to you. There may be barriers in place which make it harder to assess capacity and we need to do our best to mitigate for this. For example if you have a patient who has difficulty communicating post stroke it doesn't mean they don't have capacity, rather that we need to optimise communication methods. This can be by allowing them to write or sign or use other communication aids.
Most hospitals will have Mental capactiy act frameworks you can base your assessment off of to guide you.
The key thing is to take your time and remember you are assessing capacity for a specific decision at a specific time- eg does this patient have capacity to consent to an operation. Take it step by step. This is quite simplified and far more guidance can be found on the GMC website.
Understanding
Do they understand why they need a specific procedure
Do they understand the risks and benefits
Retention
Are they able to remember the information given to them
Weighing up
Do they understand the risks and benefits
Can they use the information to help them make a decision
Communication
Are they able to express this decision to you with evidence of the above
Other things to consider are;
whether the person may regain capacity at a later time and if we can delay making a decision until this time.
whether we know of any previously expressed wishes, advanced directives that can help us to make a decsion
if you think the patient lacks capacity we should choose the least restrictive option
Disclaimer:
This is a not for profit education resource designed for new resident doctors. All information serves as a guide to help doctors approach day to day life as an F1. It is not intended as a guide to patient care and should never be used as such or in place of advice of treating clinicians or published clinical guidelines. All cases are fictional and any resemblance is purely coincidental. Additionally all images are AI generated unless otherwise stated.
References/Resources:
GMC. Decision making and consent. https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent/about-this-guidance.