Explanation

Decisional capacity is assessed using Appelbaum's four-component model: Understanding (can the patient comprehend the relevant information?), Appreciation (can the patient recognize how the information applies to their own situation?), Reasoning (can the patient weigh options and consider consequences?), and Communicating a choice (can the patient clearly express a decision?). This assessment is decision-specific — a patient may have capacity for one decision but not another — and it is time-specific, as capacity can fluctuate. The assessment should be documented in the medical record and includes the specific decision being considered, the information provided to the patient, and the clinician's assessment of each of the four components.

Key Takeaway

Decisional capacity requires understanding, appreciation, reasoning, and the ability to communicate a choice (Appelbaum's model).