Vol XXIII, April `06

Speaking at the AMDA Foundation Spring Research Network meeting, held March 15 in Dallas, Texas, Kim noted that decision making capacity is a relatively new concept. "There are many trains of thought about what goes into it," he said.

Kim offered three levels of definitions for decision making capacity:

• Adjudicated capacity/competence--what a judge determines in a court of law
• Capacity/competence--a clinician's approximation of what the courts might say (usually this carries the day)
• Abilities relevant to capacity (these include understanding, appreciating, reasoning, and communicating a stable choice)

Because the concept of decision making capacity is fairly young and there are so many opinions regarding it, there are many challenges associated with assessing this. According to Kim, these include:

• Our moral and political concepts tend to presuppose rather than define and operationalize the concept of autonomy
• Decision making capacity tends to be broadly defined in statute; and our society relies on a procedural solution, i.e., the judgment of experts
• Task- and domain-specific understanding of decision making capacity creates many new constraints

"For practitioners such as yourselves, it comes down to a broad set of criteria and decisional solutions," Kim concluded.

Kim outlined the four abilities that must be assessed to determine decision making capacity:

• Understanding: Factual understanding and comprehension. In this sense, it is a technical use of the term and narrower than ordinary language.
• Appreciation: Applying the facts to oneself and one's own situation. This implies a certain level of rational belief (e.g., in the key points laid out by physicians).
• Reasoning: Formal aspects of manipulating information to arrive at a choice; least defined legally.
• Evidencing a choice: Patient is at least stable enough for the choice to be implemented.

Following Kim's presentation and one about "What Constitutes Refusal," the audience broke into two discussion groups to address the topics of capacity and refusal in terms of what might be included in a Research Network white paper or guideline on these topics. Additionally, the Network's study groups met to discuss progress and plan future activities relating to research on five topics: anemia, centralized database, diabetes, oral health, and osteoporosis.

Watch future issues of this newsletter for further reports from this meeting and for details about the Fall Research Network meeting, set for October 27-29, in Tampa Bay, Florida.