“You Say Yes, I Say No, You Say Stay, I Say Go”: Standardizing Decisional Capacity Assessment and Documentation
Friday, October 13, 2023
5:00 PM – 6:15 PM ET
Location: Galena (Fourth Floor)
Decision-making capacity (DMC) is a common aspect of healthcare ethics consultations, yet there is little standardization of the DMC assessment and documentation process. The absence of a standardized process has led to instances in which patients with DMC, who should have had the opportunity to express their right to make decisions about their care, have been erroneously held against their will for long periods of time in the hospital or had crucial decisions about discharge or medical care inappropriately deferred to their surrogate. Conversely, the absence of a standardized process has led to instances in which patients who lack DMC were permitted to refuse potentially life-saving treatments or were discharged from the hospital to unsafe situations when these decisions should have been made by the patient’s surrogate, in collaboration with the healthcare team and in alignment with the patient’s values and preferences. This presentation describes the efforts of a multidisciplinary group of healthcare practitioners in a large integrated healthcare system to develop, pilot and deploy tools and resources to enable healthcare practitioners to reliably and consistently assess and document DMC in a patient-centered, evidence-based manner. These include the use of a template for documentation in the electronic health record based upon recognized DMC assessment criteria for medical treatment, disposition, and choosing a surrogate and accompanying training materials to enable practitioners to reliably interpret the results of the assessment.
Joleen Sussman, PhD, ABPP – Gero/Neuro Psychology Program Manager, Behavior Medicine, Department of Veterans Affairs; Cynthia Geppert, MD, PhD, MA, MPH, MSB, DPS, MSJ, FACLP, DFAPA, FASAM, HEC-C – Director of Ethics Education, National Center for Ethics in Health Care, Department of Veterans Affairs