Decision making capacity and legal competency are not the same.

A 16-year-old with a degenerative disease and a heart problem has decided that he wants to complete an advance directive in which he states that he wants no resuscitation if he goes into cardiac arrest.

A young adult with limited cognitive skills does not want to take medication, but her family insists that she needs to be on medication for her mental health needs.

A patient who normally makes her own decisions at Kennedy Krieger has a setback, and her practitioner questions her ability to fully grasp the situation and make the best decision.

Because we serve people with developmental disabilities, including intellectual disability and mental health problems, questions about patients’ ability to make medical decisions often arise. Parents sometimes want to obtain guardianship of the patient because they believe that their child cannot make treatment decisions, or staff may believe that a patient cannot make decisions.

Recent discussions between Ethics Committee members and medical staff have highlighted the need for further discussion and understanding of the concept of Decision Making Capacity (DMC). DMC is often confused with competency. However, these terms are quite different, and these differences underscore significant ethical implications.

Competency is determined by a judge in a court of law. This legal process is typically reserved for people who are very impaired, not expected to recover, and making decisions that adversely affect their well-being.

Decision Making Capacity is a clinical assessment of a patient’s ability to understand and appreciate the nature and consequences of health decisions, and to formulate and communicate decisions concerning healthcare.

For many of our patients, the important question is one of DMC: Is this person able to make this specific medical decision at this time?