1. Mental Status
2. Judgement
- “What would you try to do if they saw a bottle that was rolling across a table?”
- “If you were walking along a sidewalk and found a stamped-and-addressed envelope sitting on the sidewalk, what would you do with it?”
3. Decision-making capacity
- Understanding
- States the meaning of relevant info
- E.g. dx, risks/benefits of procedure, indications, and options of care
- “Can you tell me in your own words what I just said about ”
- Impaired in: problems with memory, attention span, intelligence; advanced dementia
- Appreciation
- Explains how information applies to oneself
- “Regardless of what your choice is, do you think it is possible the medication can harm you?”
- “Regardless of what your choice is, do you think that it is possible the medication can benefit you?”
- “Can you tell me in your own words what you see as your medical problem?”
- Impaired in: denial; delusional disorder; advanced dementia
- Reasoning
- Can compare information and infer consequences of choices.
- “How could X affect your daily activities?”
- “How is X better than Y?”
- Impaired in: depression; psychotic thought disorder; anxiety; phobia; delirium; advanced dementia
- Expressing a choice
- States a decision
- Impaired in: psychiatric disorders; extreme (pathologic) indecision; advanced dementia