What can I do to help? In search of best practices for being involved with capacity assessments

Abstract: Healthcare ethics consultants (HECs) must help clarify relevant ethical concepts in order to resolve questions involving value uncertainty in the delivery of healthcare. One concept is decision-making capacity, the possession of which is to be determined by a responsible clinician on the basis of a clinical assessment. Yet consultations requests from such clinicians raise a question: to what extent should HECs be involved with making capacity assessments? On the one hand, it is reasonable to suppose that because HECs are not necessarily licensed clinicians, they are only to perform an advisory role in clarifying capacity as a clinical concept and recommend escalation to a more experienced clinician or service if the assessment is complex. On the other, because it is often central to their analysis in many cases, HECs tend to have expertise on the content of the four elements, how they relate to decision-specific circumstances, and what level of capacity is needed for specific treatments, which makes their perspectives valuable to clinicians. In this panel, three HECs from diverse disciplinary backgrounds will evaluate the unique contributions HECs may offer in capacity assessments with consideration to our professional role, skills, and code of ethics. Panelists will draw from our clinical experiences to construct case vignettes that highlight the benefits and limitations to their approaches. Overall, our aim is to generate discussion about the extent to which clinical ethicists should be involved in capacity assessments and what some best practices might be for documenting our involvement in a patient’s record.