Assessing decision-making capacity: the clinical basics

It is within the scope of practice of all doctors and a number of other health professionals (e.g. nurse practitioners) to assess decision-making capacity and obtain informed consent.

The PPPR Act defines a 'relevant health practitioner' as someone whose 'scope of practice includes the assessment of a person’s mental capacity' (section 94(4)a).

This course is part 1 of a 2-part module:

1. In this course, Assessing decision-making capacity: the clinical basics you will learn about the relevant principles when assessing decision-making capacity, and learn how to perform a capacity assessment using a 3-stage approach.
2. In Decision-making Capacity: the legal aspects you will learn about the requirements for a formal assessment. This is important as you need to understand the legal framework for substitute welfare and financial decision-making to support people who may lack capacity to make decisions for themselves.

At the end of this course, you will be able to:

• Understand the definition of decision-making capacity and informed consent;
• Understand the four abilities of capacity – understand, retain, use or weigh, and communicate;
• Perform a capacity assessment using the 3 staged approach: preparing for the assessment; the assessment interview; after the interview;
• Appreciate the importance of having a culturally responsive practice, and Tikanga Māori, when performing a capacity assessment.

Acknowledgements

This course was created by Dr Gary Cheung (Psychiatrist, FRANZCP, Auckland) and Dr Alisha Vara (Registrar, Auckland Regional Psychiatric Training Programme) in partnership with Alison Douglass (Barrister, LLB MBHL, Dunedin) and Dr Greg Young (Psychiatrist, FRANZCP, Hawkes Bay) in 2018. The wider project team also includes Dr Fred Sundram (Psychiatrist, PhD, Auckland), Dr Marcus Henning (Associate Professor, PhD, Auckland), and Prof Ngaire Kerse (Professor, PhD, Auckland).

We especially acknowledge the contribution of Alison Douglass, 2014 recipient of the New Zealand Law Foundation International Research Fellowship. This course is based on the Toolkit for Assessing Capacity from Alison’s mental capacity report co-authored with Dr Greg Young and Professor John McMillan.