Explanation

The distinction between capacity and competency is fundamental to clinical practice and legal proceedings. Capacity is a clinical determination made by healthcare providers at the bedside. It is decision-specific (a patient may have capacity for one decision but not another), time-specific (it can fluctuate and should be reassessed), and does not require court involvement. Any licensed clinician can assess capacity, though psychiatrists are often consulted for complex cases. Competency, on the other hand, is a legal determination made by a judge through a court proceeding. It results in a formal legal status — a person is presumed competent until a court rules otherwise. A finding of incompetency typically leads to appointment of a guardian or conservator. The practical implication is that a clinician may determine a patient lacks capacity for a specific decision, but the patient remains legally competent until a court says otherwise.

Key Takeaway

Capacity is clinical (assessed by clinician, decision-specific, can fluctuate). Competency is legal (determined by court).