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This article reviews the concepts of capacity and competency with regard to clinical practice. More specifically, it discusses the foundational ethical principles of respect for persons, beneficence, and justice, the importance of a thorough understanding of these principles, and the difference between capacity and competence. Finally, this article analyzes how to assess and document capacity for medical decision-making. Objectives: Review the relevant definitions of competency, capacity, tort, informed consent, medical provider, respect for persons, beneficence, and justice. Identify situations in which a capacity assessment is indicated. Outline how to assess and document capacity for medical decision-making. Summarize why assessment and documentation of capacity is imperative for patient safety and protection of providers from legal retribution. Access free multiple choice questions on this topic.

The Hippocratic Oath instructs physicians and other medical providers to first, “do no harm”. Similarly, the three ethical principles laid forth in the Belmont Report ask providers to prioritize respect for persons, beneficence, and justice in their daily practice. While is it critical for providers of medical care to uphold these tenets, frequently situations arise where it is impossible to fulfill all. Medical providers are tasked with multiple roles simultaneously - healer, patient advocate, protector of hospital staff, guardian of public health, citizen, and a humanist and spiritual being. Providers must be prepared for the situation that places these roles and priorities at odds. This article will discuss relevant definitions, delve further into the ethical principles introduced above, and prepare medical providers for how to approach these complex patient encounters with the intent of maximizing benefit for all and protecting the provider(s) involved.

Regarding documentation; a safe rule to follow is the ubiquitous adage, “if it’s not documented, it didn’t happen”. These situations are high-risk from a medico-legal perspective and providers should document accordingly. Emergency department providers have been shown to have suboptimal documentation habits, particularly in high-risk scenarios [15]. Taking several minutes immediately after performing the mental status exam and capacity determination to thoroughly document the exam and capacity determination is essential and should be prioritized. Remember that unless and until a complete capacity assessment has been performed and documented, performing procedures and treatments without patient consent is both unethical and illegal.