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Fact Sheet

Capacity and Competency Evaluations

August 2, 2025

Dr. Aziz has no financial relationships with companies related to this material.
Full Fact Sheet Editorial Information

You may be asked to determine decision-making capacity (DMC) in various situations, such as consent for medical procedures, for leaving the hospital against medical advice, or for other major decisions. In this fact sheet, I suggest an approach to evaluating DMC and what to do if you conclude that DMC is impaired.

Fact Sheet

How to Evaluate Capacity to Make Decisions

January 1, 2025

Victoria Hendrick, MD and Daniel Carlat, MD

Dr. Hendrick and Dr. Carlat have no financial relationships with companies related to this material.
Full Fact Sheet Editorial Information

Conducting a capacity evaluation is a critical aspect of health care, particularly when you’re faced with patients who may not be able to make informed decisions about their treatment.

Expert Q&A

Identifying and Addressing Ageism in Psychiatric Practice

July 1, 2024

A. Mark Clarfield, MD, FRCPC

A. Mark Clarfield, MD, FRCPC.

Professor emeritus; Director, Centre for Global Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva; Chairman, National Council on Geriatrics Israel.

Dr. Clarfield has no financial relationships with companies related to this material.

Addressing ageism can improve a patient’s sense of self and independence. Dr. Clarfield provides practical suggestions.

Expert Q&A

Ethical Principles and Capacity Assessment in Dementia Care

April 1, 2024

Paul Appelbaum, MD

Paul S. Appelbaum, MD

Dollard Professor of Psychiatry, Medicine, & Law; Director, Center for Law, Ethics, and Psychiatry, Columbia University, New York, NY. Co-author of Assessing Competence to Consent to Treatment (Oxford University Press; 1998).

Dr. Appelbaum has no financial relationships with companies related to this material.

Dr. Appelbaum provides suggestions on adapting a capacity assessment for people with dementia.

Clinical Update

Navigating Ethical Challenges in Geriatric Psychiatry

April 1, 2024

Meera Balasubramaniam, MD

Meera Balasubramaniam, MD. Associate Medical Director, Penn Medicine Princeton House Behavioral Health, Hamilton, NJ.

Dr. Balasubramaniam has no financial relationships with companies related to this material.

Treatment of older adults comes with specific ethical challenges. Here we show you how to evaluate an older adult’s capacity to live independently, manage their finances, and drive safely. We also discuss advance healthcare planning and how to spot elder abuse.

Clinical Update

Capacity Evaluation

October 31, 2023

Rehan Aziz, MD

Rehan Aziz, MD. Associate program director, geriatric psychiatry fellowship program, Jersey Shore University Medical Center, Neptune, NJ; associate professor of psychiatry and neurology, Hackensack Meridian School of Medicine, Nutley, NJ.

Dr. Aziz has no financial relationships with companies related to this material.

A patient’s decision-making capacity is not an all-or-nothing phenomenon. Here we review its four components and how to individualize your assessment based on a patient’s unique situation.

Responding to Sexual Activity on the Inpatient Psychiatric Unit

March 23, 2022

Husna Najand, MD.

Husna Najand, MD. Olive View—UCLA Psychiatry Residency Program. Dr. Najand has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

The unit staff inform you that two patients on the unit are engaging in sexual activity. What do you do next? Dr Najand reviews guidelines for managing sexual incidents, both consensual and nonconsensual.

A Primer for Psychiatrists on Court Hearings

January 7, 2022

Ashley H. VanDercar, MD, JD.

Ashley H. VanDercar, MD, JD.
Psychiatrist, Northcoast Behavioral Healthcare, Northfield, OH.

Dr. VanDercar has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Dr. VanDercar draws from her backgrounds in both law and psychiatry to educate us about testifying in court hearings.

Decisional Capacity

May 21, 2021

Erick Cheung, MD

Erick Cheung, MD

Associate Medical Director, UCLA Resnick Neuropsychiatric Hospital. Chief Quality Officer, Department of Psychiatry, UCLA, Los Angeles, CA. Dr. Cheung has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Patients sometimes refuse necessary, even lifesaving, treatments. How do we know they are making informed and reasonable decisions? Dr. Cheung summarizes key points in evaluating patients’ decisional capacity.

Capacity Assessment in Pregnant Patients

May 21, 2021

Saba Syed, MD

Saba Syed, MD Director of Consultation and Liaison Psychiatry, Olive View-UCLA Medical Center. Clinical Professor, UCLA. Bioethics Committee Chair, Olive View-UCLA Medical Center. Consultation-Liaison, Olive View Medical Center, Los Angeles, CA. Dr. Syed has disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.

Imagine working with a pregnant, mentally ill woman who refuses critical obstetric interventions. Dr. Syed walks us through the steps to determine if these patients lack decisional capacity and explains how we can arrange for surrogate decision-makers.