Toolkit for

Primary Care:
Capacity
Assessment

Donna Scott, RN, BScN, CHRP

GIIC Resource Consultant
Regional Geriatric Program of SW Ontario
Parkwood Hospital, London
Donna.scott@sjhc.london.on.ca

Toolkit for Primary Care:

Capacity Assessment
This educational resource kit has been prepared for the Ontario primary care
sector (Family Health Teams and Community Health Centres) to use as a
learning tool for understanding capacity and capacity assessments in older
adults. It can be used as a self-directed learning package, as well as, a
resource tool for the inter-professional primary care health team.
This toolkit includes information on capacity and capacity assessment, decision
aids/tools that can be used during the process of assessing capacity, a
knowledge test and case studies.

Learning Objectives
At the completion of this module, the learner will be able to:
1. Describe the meaning of capacity assessment and its key elements.
2. Understand approaches to capacity assessment and risk identification.
3. Apply knowledge of capacity assessment using case studies.

Primary Care

Capacity Assessment

September 2008

Table of Contents
Capacity: What is it?

Page 4

Required Decision-Making Abilities for Capacity

Page 5

Key Elements of Capacity

Page 6

Relevance

Page 8

Points to Remember

Page 8

The Four Cs of Capacity

Page 9

Measuring Capacity

Page 9

Decision Aids / Tools

Page 10

Risk vs Capacity

Page 11

Legislation

Page 13

Formal Capacity Assessment

Page 14

Additional Resources

Page 15

Reference List

Page 16

Appendix A: Reference Sheet- Decision-Making

Abilities

Page 18

Appendix B: Aid To Capacity Evaluation (ACE) Tool Page 19

Appendix C: Case Study Using ACE

Page 22

Appendix D: Risk Assessment Framework

Page 25

Appendix E: Identifying Risks Worksheets

Page 28

Appendix F: Case Studies

Page 31

Appendix G: Knowledge Test

Page 33

Primary Care

Capacity Assessment

September 2008

Capacity Assessment
Introduction
Assessing a patients decision-making capacity is part of every patient encounter.
For the most part the process is spontaneous and straight forward. Through
dialogue, the clinician is able to confirm that the patient understands their health
situation and options for care.
In recent years, some important socio-demographic changes have made capacity
assessment more prominent. Our population is aging and the prevalence of
cognitive deficits, dementia and co-morbidities has increased. The cognitive and
physical changes that are occurring in the aging population are linked with declines
in every-day functioning that includes the loss of decision-making skills. As a
result, there are times when there is a need to assess a patients decision-making
capacity more thoroughly.

Capacity: What Is It?

Capacity is defined as the ability to both understand information relevant to a
decision and to appreciate the consequences of a decision.
(Etchells et al 1996, Gregory et al 2007, Ministry of the Attorney General 2005)

Understand: Ability to focus on factual understanding.

Ability to cognitively grasp and retain information.
Ability to process information regarding available options
and risks.
Appreciate:

Ability to reason and the ability to attach personal meaning to

decisions.
Ability to realistically appraise potential outcomes and the ability to
justify choices.

(Etchells et al 1996, Gregory et al 2007, Ministry of the Attorney General 2005)

Primary Care

Capacity Assessment

September 2008

Required Decision-Making Abilities for Capacity

There are four decision-making abilities that patients require to be able to
demonstrate capacity (Ganzini et al 2005, Lai & Karlawish 2007, Moye et al 2004,
Qualls & Smyer 2007). These abilities are :

Ability
Ability
Ability
Ability

to
to
to
to

understand relevant information.

appreciate the situation and its consequences.
reason.
communicate and express a choice.

The presence of each of these abilities needs to be determined. Clinical

presentation may vary and each decision-making ability is assessed individually.
Probing questions can be used to assist in this process.
1. Ability to understand relevant information
This is the ability to comprehend basic information about a problem, its potential
solutions, and the risks and benefits associated with those solutions. Factors
influencing this ability include the patients level of education and intelligence and
how the information is presented.
Probing questions that can be used to determine:
What is your understanding of your condition?
What options are available for your situation?
What do you understand about the benefits of treatment?
How will the treatment help you?
What do you think would happen if you decide not to have treatment?
2. Ability to appreciate the situation and its consequences
This is the ability to recognize how a problem or solution pertains to ones own
situation. Factors influencing this ability include the type of decision to be made
and the complexity of the situation.
Probing questions that can be used to determine:
What do you believe is wrong with your health now?
Do you believe that it is possible that this treatment/diagnostic test could
benefit you?
Do you believe that it is possible that this treatment/diagnostic test could harm
you?
We have talked about other possible treatments for you. Can you tell me what
they are?
Primary Care

Capacity Assessment

September 2008

 What do you believe would happen to you if you decided not to have this
treatment/diagnostic test?
3. Ability to reason
This is the ability to consider potential solutions to problems by:
describing how a solution would affect his or her everyday life.
demonstrating how one solution is better in comparison to another.
demonstrating logical thought processes in determining a choice.
Probing questions that can be used to determine:
Tell me how you reached your decision to have (or not have) this
treatment/diagnostic test?
What things were important to you in making this decision?
4. Ability to communicate and express a choice
This is the ability to render a clear choice for the decision under consideration. This
choice should be consistent with:
Expressed beliefs and values.
Previous decisions and actions.
Cultural or religious beliefs.
This ability is often preserved despite impairments in the other decision-making
abilities.
Probing questions that can be used to determine:
You have been given a lot of information about your condition/situation.
Have you decided what option is best for you?
Have you made a decision about which treatment you want to proceed with?
A reference tool outlining these decision-making abilities and probing questions is
included in this toolkit (Appendix A).
(Lai & Karlawish 2007, Ganzini et al 2005, Moye et al 2004,Moye & Marson 2007, Qualls & Smyer 2007, Tunzi 2001 )

KEY ELEMENTS OF CAPACITY

A. PRESUMPTION OF CAPACITY
In our society, people are presumed capable to make choices for themselves,
unless proven otherwise. The onus is on the clinician to prove incapacity.
(Etchells et al 1996, Ganzini et al 2003, Ganzini et al 2005, Ministry of the Attorney General 2005,
Qualls & Smyer 2007)

Primary Care

Capacity Assessment

September 2008

Incapacity is often reversible. Illness can temporarily impair capacity and it can be
regained upon recovery. If a person appears incapable, the clinician should
determine whether reversible factors are present.
Medical conditions which could temporarily impact capacity include:
Infection eg. pneumonia, UTI, influenza, herpes zoster
Endocrine disorders eg. diabetes, hypothyroidism, hyperthyroidism
Cardiovascular disease, hypertension
COPD
Obstructive sleep apnea
Disturbances in fluid/electrolyte balance eg. renal disease, dehydration,
malnutrition
Chronic pain
Adverse effects of medication
Delirium
Mental health issues eg. Depression, psychosis.
Assessments should be focused on enhancing independence and allowing people to
make decisions where possible. Recent research has demonstrated that most
individuals in the earliest stages of dementia would not be deemed incapable and
should be encouraged to participate in decision-making. There is evidence that
many patients with more moderate Alzheimers Disease can continue to express a
choice when presented with two relatively simple options.
Retrospective studies have revealed that families recognize signs of declining
cognitive abilities approximately one year before seeking medical evaluation.
Typically, help is sought when safety is a concern.
(Etchells et al 1996, Ganzini et al 2003, Ganzini et al 2005, Ministry of the Attorney General 2005,
Qualls & Smyer 2007)

B. CAPACITY IS DOMAIN-SPECIFIC AND DECISION-SPECIFIC

The concept of global capacity, that is, people considered capable or incapable for
all decisions, is no longer held. Within personal care decision-making, for example,
there are six domains: health care, nutrition, clothing, shelter, hygiene and safety.
It is currently recognized that people may have capacity in one domain but lack
capacity in another. Each domain is tested separately.
As well, within each domain, there is a hierarchy of decisions that could be made
from simple to complex. A person may be capable of making simple decisions but
incapable of making complex decisions.
eg. May be able to making simple grocery purchases but unable to handle
banking activities.
Primary Care

Capacity Assessment

September 2008

May be able to make decision regarding having the flu vaccine but unable to
consent to surgery.
Capacity assessment focuses on the specific abilities that an individual needs to
make a decision regarding a specific decision/situation.
i.e medical care decisions, managing money, personal care decisions, driving a
car, moving to LTCH
The seriousness of a decision does not always correspond with the complexity of
the decision.
Factors that influence the complexity of a decision include:
Number of choices available.
Number and variety of potential consequences to be considered for each
option.
Degree of uncertainty about the chance of encountering each outcome.
(Ganzini et al 2003, Ganzini et al 2005, Ministry of the Attorney General 2005, Tunzi 2001, Zayas et al 2005)

RELEVANCE
A declaration of incapacity removes a fundamental freedom and right to make
choices for oneself. People should only be declared incapable when it has been
firmly established that they lack the ability to make decisions or are at serious risk
(Silberfeld & Fish 1994, Qualls & Smyer 2007)
because of their incapacity.

POINTS TO REMEMBER
Capacity is an essential component of valid consent.
Capacity is NOT a test result or a diagnosis.
Capacity deals with the process of decision-making and does not depend on
the actual choice made.
Capable people are able to make rational decisions, based on their values,
goals, knowledge and understanding of the issues facing them they have
the ability to identify and accept risks.
Capacity is not a single ability that people have or not have we use different
abilities to make different kinds of choices capacity is task-specific.
Assessing capacity requires a consideration of the whole person it is not
related to an illness, diagnosis or living situation. Eg. Living in a LTCH does
not make an individual globally incapable
Need to balance autonomy (self-determination) and beneficence (protection)
(Cooney et al 2004, Etchells et al 1996, Ganzini et al 2003, Moye & Marson 2007, Qualls & Smyer 2007)

Primary Care

Capacity Assessment

September 2008

The Four Cs of CAPACITY

There are other ways to understand capacity. One of these is The Four C`s of
Capacity:
Context
Choices
Consequences
Consistency

Does the person understand the situation they are facing?

Does the person understand the options?
Does the person understand the possible ramifications of
choosing various options?
Do they fluctuate in their understanding of choices?

MEASURING CAPACITY
There is no single assessment tool for capacity. However, as a minimum, clinicians
need a reliable and valid process as capacity is a multi-dimensional concept (Cooney et
al 2004, Etchells et al 1996, Ganzini et al 2003, Gregory et al 2007). Generally speaking, capacity
assessment builds on the principles and techniques of good geriatric assessment, in
which the process is tailored to the educational, cultural, psychological, social and
sensory characteristics of the person being assessed (Qualls & Smyer 2007).
Capacity assessment should only be performed if it serves the best interests of the
person the assessment should not be performed to serve the interests of others.
There is no evidence that scores from standard tests of cognitive ability are a
reliable indicator of capacity, partly because they are language-based and
influenced by education, culture & language. Most measures of cognitive status do
not evaluate cognitive functions such as judgment and reasoning, which are
relevant to capacity. These can be used as screening tools to help inform a clinical
capacity assessment but should not be used in isolation. A comprehensive
assessment of the patient should always be undertaken.
(Cooney et al 2004, Etchells et al 1996, Ganzini et al 2003, Gregory et al 2007)

Assessment may fail to find capacity because:

It is not present
Process used was inadequate
Person applying the process failed to understand, appreciate or apply the
process properly.
(Ganzini et al 2003)
Decisional tools/aids can be helpful to guide the process and include:
Aid to Capacity Evaluation (ACE)
Capacity Assessment Tool (CAT)
Assessment of Capacity for Everyday Decision-Making (ACED)
MacArthur Competence Assessment Tool Treatment (Mac-CAT-T).
Primary Care

Capacity Assessment

September 2008

These are included to increase your awareness of available resources and are not
endorsed by the author of this toolkit.
Aid to Capacity
Evaluation (ACE)

Semi-structured interview
Addresses 6 facets of capacity for a medical decision:
medical problem
treatment
alternatives to treatment option of refusing treatment
ability to perceive consequences of accepting or refusing
ability to make decision, not based on depression or delusions
copy of ACE and case study using ACE tool are included in
this toolkit (Appendix B and Appendix C).
available: www.utoronto.ca/jcb/_ace
(Etchells et al 1996)

Capacity Assessment
Tool (CAT)

Structured interview
The specific use of this tool is to assess capacity to choose
between two options in an actual treatment situation.
Evaluates capacity based on 6 abilities:
communication
understanding choices
insight
decision/choice process
comprehension of risks and benefits
judgment

Assessment of Capacity
for Everyday DecisionMaking (ACED)

Carney, M.T., Neugroschl, J., Morrison, R.S., Marin, D., & Sui, A.L. (2001). The
development and piloting of a capacity assessment tool. Journal of Clinical Ethics,
12(1), 17-23.

Semi-structured interview

Assesses four decision-making abilities:

understanding
appreciation
reasoning
expressing a choice
Useful for assessing capacity of older persons with very mild to
moderate cognitive impairment to make decisions about how to
manage their Instrumental Activities of Daily Living (IADL)
disabilities.
Lai, James M., Gill, Thomas M., Cooney, Leo M., Bradley, Elizabeth H., Hawkins, Keith A.,
& Karlawish, Jason H. (2008). Everyday Decision-Making Ability in Older Persons With
Cognitivie Impairment. American Journal of Geriatric Psychiatry, 16(8), 693-696.

MacArthur Competence
Assessment Tool
Treatment
(Mac-CAT-T)

Semi-structured interview
Assesses and rates patients abilities related to four standards for
competence to consent to treatment:
understanding
appreciation
reasoning
expressing a choice
Grisso, T. & Applebaum, P.S. (1998). Assessing Competence to Consent to
Treatment. New York: Oxford University Press

Primary Care

Capacity Assessment

September 2008

10

RISK VS. CAPACITY

Embedded in a capacity assessment is a risk assessment. At risk means there is
a chance of suffering or injury. The issues that triggered the capacity assessment
need to be addressed regardless of the assessment outcome. (Silberfeld & Fish, 1994)
The clinician needs to distinguish between tolerable risks and intolerable risks.
Only intolerable risks require assessment of capacity. The best evidence of
intolerable risk is indication that:
the behaviour is new and unprecedented - not consistent with past
behaviour.
the behaviour is causing harm.
e.g. in past, paid bills and managed banking, prided himself in financial
self-sufficiency to now, withdrawing large amounts of cash, inappropriate
spending.
An important factor in risk assessment is whether a person chooses to engage in
risky behaviour, despite being aware of the potential consequences. Competent
people do sometimes choose to live at risk.
(Qualls & Smyer 2007, Silberfeld & Fish, 1994)

Identifying risk
As a clinician, you will have patients who are living at risk. Questions to consider in
identifying risk include:
Is there concrete evidence to suggest a person is at risk of harm to
themselves or others?
Is the risk actual (is the problem happening now?) or potential (could the
problem happen in the future)?
Worksheets to assist with the identification of risks are included in this toolkit
(Appendix D).

Assess the factors that may affect capacity and risk

There are a number of factors that can potentially affect capacity and risk. These
factors need to be considered during the assessment and include:
Supports (human & physical) that alleviate or contribute to the risk.
Patients ability and willingness to use these supports.
Patients values and beliefs.
Patients tolerance level for various risks.
Caregivers values and beliefs.
Caregivers tolerance level for various risks. (Silberfeld & Fish 1994)

Primary Care

Capacity Assessment

September 2008

11

Level of Risk
Geriatrician, Dr. Karen Fruetel has developed a model for considering levels of risk.
In some situations, risk within a domain may be tolerable up to some point.
However, beyond this identified level, the risk becomes intolerable.

Nutrition

Medication Compliance

Forgetting to eat
Rotten food
Unable to access food
_ _ _ _ _ _ _ _ _ _ _ _ threshold for
risk
Inappropriate food
Eats in restaurant

Congestive heart failure

Diabetes
_ _ _ _ _ _ _ _ _ _ _ _ threshold for
risk
Hypertension
Arthritis
Vitamins
Dr. Karen Fruetel, Living with Risk & Dementia
SWOGAN Conference April 2002

Not following prescribed diet carries less risk

than not eating.

Not taking OA meds will increase pain &

decreases mobility but there is no
imminent harm. Not taking
anti-hypertensive increases risk of stroke.
There is greater harm if diabetes meds are
not taken.

Dr. Fruetel has developed a Patient Risk Assessment Framework. It can be used to
guide the clinician through the process of identifying patient risks and is included in
this toolkit (Appendix D)

Principles to Guide Patient Decisions

In situations where a patient is found to be incapable and decisions will be made on

behalf of the patient, certain principles should be considered in rendering a
decision. These principles include:
Least restrictive environment.
Balance autonomy and safety.
Person-environment fit optimal outcomes occur when a persons capabilities
are optimally supported and challenged by the environment.
(Qualls & Smyer 2007)

Primary Care

Capacity Assessment

September 2008

12

LEGISLATION
In Ontario, there is legislation which impacts capacity assessment.

Health Care Consent Act (1996)

Covers two areas of consent: Consent to treatment and Admission to LTC
Home or Home for Aged
Consent to Treatment

Admission to LTC facility

The health practitioner proposing the

treatment is responsible for getting the
consent.

Same as for Consent to Treatment except

capacity is defined as:
Be able to understand current
challenges in living situation.
Be able to appreciate consequences of
decisions about living situation.

A valid consent must be:

Informed the patient must be given
information needed to make a decision
and have their questions answered.
Voluntary not obtained through
misrepresentation or fraud.
Obtained from a capable person the
patient must understand and must
appreciate.
Documented.
Consent may be :
Implied vs. Explicit
Verbal vs. Written

Identifies the appropriate Substitute Decision-Maker (SDM) for an incapable

person
SDMs should give/refuse consent based on:
Prior known wishes (written or verbal)
If no applicable wish is known or it is impossible to comply with the wish,
the SDM shall give or refuse consent in the incapable persons best
interests considers persons values and beliefs, whether treatment will
improve persons condition or well-being or prevent deterioration of
condition, whether the expected benefits outweigh the risk of harm

Primary Care

Capacity Assessment

September 2008

13

Substitute Decisions Act (1992, amended 1996)

Allows for a capable person to complete a Power of Attorney (POA) to grant
another person or persons authority to make decisions on his or her behalf.
Outlines how guardianship for property and/or personal care are created or
appointed.
Three types of POA:
1. Power of Attorney for Personal Care gives authority to make decisions
about healthcare, nutrition, shelter, clothing, hygiene and safety.
2. Continuing Power of Attorney for Property gives authority to deal with
property and money and remains valid if the person who signs it
becomes incapable.
4. General Power of Attorney for Property valid only when the person who
signs it is capable not useful if planning for incapacity.

Mental Health Act

Governs the fair and equal treatment of all persons who require mental health
Services
Requires the attending physician to assess capacity to manage property when a
patients is admitted to a Schedule 1 Psychiatric Facility
( www.e-laws.gov.on.ca)

FORMAL CAPACITY ASSESSMENT

In certain circumstances, formal capacity assessments are required. These
assessments are completed by assessors trained through the Ministry of the
Attorney General. The most common reasons include:
When there is no family and a guardian must be appointed.
When there is conflict within a family.
When some specific specific financial transaction must occur.

Primary Care

Capacity Assessment

September 2008

14

Additional Resources
1. Educational slide deck on Capacity Assessment
- For Primary Care Inter-Professional Team
- Contact Donna Scott, GIIC Resource Consultant
Telephone : 519-685-4292 Ext. 42337
Email : donna.scott@sjhc.london.on.ca

2. Case Studies
Two case studies are provided in this toolkit and can be used to apply
knowledge and understanding of capacity assessment (Appendix F).
3. Knowledge Test - Test Your Understanding
included in this toolkit (Appendix G)

4. Tool on Capacity and Consent Ontario Edition

Produced by the Advocacy Centre for the Elderly
(website: www.advocacycentreelderly.org) and the National Initiative
for the Care of the Elderly (website: www.nicenet.ca).
5. Ministry of the Attorney General The Capacity Assessment Office
Questions and Answers
Available:
www.attorneygeneral.jus.gov.on.ca/english/family/pgt/capacityoffice.pdf

6. A Practical Guide to Capacity and Consent Law of Ontario for Health

Practitioners Working with People with Alzheimer Disease - The
Dementia Network of Ottawa
Available : www.alzheimerott.org/graphics/center/consentlaw.pdf

Primary Care

Capacity Assessment

September 2008

15

Reference List: Capacity Assessment

Black, Kathy and Osman, Hana. (2005). Concerned about client decision-making capacity?
Considerations for Practice Care Management Journals, 6 (2), 50-55.
Carney, M.T.., Neugroschl, J., Morrison, R.S., Marin, D., & Sui, A.L. (2001).
The development and piloting of a capacity assessment tool. Journal of Clinical
Ethics, 12(1), 17-23.
Cooney, L., Kennedy, G., Hawkins, K., & Hurme, S.(2004). Who can stay at home? Assessing
the capacity to choose to live in the community. Arch Intern Med , 164:357-360
Etchells, E., Sharpe, G., Elliott, C., & Singer, P.A. (1996). Bioethics for clinicians: 3. Capacity.
CMAJ 155: 657-661.
Ganzini, L., Volicer, L., Nelson, W., & Derse, A. ( 2003). Pitfalls in Assessment of DecisionMaking capacity. Psychosomatics 2993; 44:237-243.
Ganzini, Linda, Volicer, Ladislav, Nelson, William A., Fox, Ellen, and Derse, Arthur R. (2005).
Ten myths about decision-making capacity. Journal of the American Medical Directors
Association, 6( 3), S100-S104.
Gregory, R., Roked, F., Jones, L., and Patel, A. (2007). Is the degree of cognitive impairment in
patients with Alzheimer's disease related to their capacity to appoint an enduring power of
attorney? Age & Ageing, 36(5), 527-31.
Grisso, T. & Applebaum, P.S. (1998). Assessing Competence to Consent to
Treatment. New York: Oxford University Press.
Gurrera, Ronald J., Karel, Michele J., Azar, Armin R., and Moye, Jennifer. (2007). Agreement
between instruments for rating treatment decisional capacity. American Journal of Geriatric
Psychiatry , 15 (2), 168-173.
Lai, James M and Karlawish, Jason. (2007). Assessing the capacity to make everyday
decisions: a guide for clinicians and an agenda for future research American Journal of Geriatric
Psychiatry ,15 (2), 101-111.
Lai, James M., Gill, Thomas M., Cooney, Leo M., Bradley, Elizabeth H., Hawkins, Keith A.,
& Karlawish, Jason H. (2008). Everyday Decision-Making Ability in Older Persons With
Cognitive Impairment. American Journal of Geriatric Psychiatry, 16(8), 693-696.
.
Primary Care

Capacity Assessment

September 2008

16

Ministry of the Attorney General. The Capacity Assessment Office: Questions and Answers.
http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/capacityoffice.pdf.
Moye, Jennifer, Karel, Michele J., Azar, Armin R., and Gurrera, Ronald J. (2004). Capacity to
consent to treatment: empirical comparison of three instruments in older adults with and without
dementia. Gerontologist, 44( 2), 166-175.
Moye, J. and Marson, D. C. (2007). Assessment of decision-making capacity in older adults: an
emerging area of practice and research. Journals of Gerontology , 62B(1), 3-11.
Ontario Ministry of the Attorney General. (2000). A Guide to the Substitute Decisions Act.
Toronto, ON: Publications Ontario. Retrieved from:
http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/sdaact.asp.
Ontario Ministry of the Attorney General. (2005). Guidelines for Conducting Assessments of
Capacity. Toronto, ON: Capacity Assessment Office. Retrieved from:
http://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/capacity/2005-06/guide-0505.pdf.
Qualls, Sara & Smyer, Michael. (2007). Changes in decision-Making Capacity in Older Adults:
Assessment and Intervention. Hobeken, New Jersey: John Wiley & Sons, Inc.
Silberfeld, Michel & Fish, Arthur. (1994). When the mind fails: a guide to dealing with
incompetency. Toronto, ON: University of Toronto Press.
Straus, S., & Stelfox, T. (2007) .Whose life is it anyway? Capacity and consent in Canada
CMAJ: Canadian Medical Association Journal 2007 Nov 20; 177(11): 1329 (2 ref).
The Dementia Network of Ottawa. (2003). A Practical Guide to Capacity and Consent Law of
Ontario for Health Practitioners Working with people with Alzheimer Disease. Ottawa, ON:
Author.
Tunzi, M. (2001). Can the patient decide? Evaluating patient capacity in practice. American
Family Physician, 64(2), 299-306.
Zayas, L. H., Cabassa, L. J., and Perez, M. C. (2005). Capacity-to-consent in psychiatric
research: development and preliminary testing of a screening tool. Research on Social Work
Practice , 15(6), 545-56

Primary Care

Capacity Assessment

September 2008

17

Primary Care

Capacity Assessment

September 2008

18

Appendix B: Aid to Capacity Evaluation (ACE)

Primary Care

Capacity Assessment

September 2008

19

Primary Care

Capacity Assessment

September 2008

20

Primary Care

Capacity Assessment

September 2008

21

Appendix C: Case Study Using Aid to Capacity Evaluation (ACE)

Primary Care

Capacity Assessment

September 2008

22

Primary Care

Capacity Assessment

September 2008

23

Primary Care

Capacity Assessment

September 2008

24

Primary Care

Capacity Assessment

September 2008

25

Appendix D: Risk Assessment Framework (Page 1)

Primary Care

Capacity Assessment

September 2008

26

Appendix D: Risk Assessment Framework (Page 2)

Primary Care

Capacity Assessment

September 2008

27

Appendix E: Identifying Risks Worksheets

Primary Care

Capacity Assessment

September 2008

28

Primary Care

Capacity Assessment

September 2008

29

Primary Care

Capacity Assessment

September 2008

30

Appendix F: Case Studies

Primary Care

Capacity Assessment

September 2008

31

Primary Care

Capacity Assessment

September 2008

32

Appendix G: Knowledge Test

Self-Directed Learning: Myths about Decision Making Capacity
Test Your Understanding

1. Decision-making capacity and competency are different concepts.

2. When a patient goes against medical advice, you can presume that they
lack decision-making capacity.

3.

4. Patients with some levels of cognitive impairment may still have decisionmaking capacity.

5. Absence of decision-making capacity is a permanent condition.

6. Decision-making capacity would not need to be assessed if the patient

agrees with the proposed treatment.

7. Decision-making capacity is impacted by the relevance and consistency of

the information provided to the patient regarding their condition.

8. Patients with certain psychiatric disorders lack decision-making capacity.

9. A patient who is involuntarily committed may still be capable of making

decisions regarding their care.

F 10. Only mental health experts can assess decision-making capacity.

Decision-making capacity is an all or nothing phenomenon.

Recommended reading:
Ganzini, Linda, Volicer, Ladislav, Nelson, William A., Fox, Ellen, and Derse, Arthur R. (2005).
Ten myths about decision-making capacity. Journal of the American Medical Directors
Association, 6( 3), S100-S104.

Primary Care

Capacity Assessment

September 2008

33

Primary Care

Capacity Assessment

September 2008

34