Capacity Assessment
...lly the patient would assent to the physician to performing a capacity assessment. If assent was given then the patient’s autonomy would still be intact because free will would not be forcibly breached. If assent is not given then the physician needs to continue with the following steps in the capacity assessment model. The third and fourth steps of the ‘capacity assessment model’ are fairly similar and can be seen to work together. “Information is gathered to describe the context, choices and their consequences” and “the person is educated about the decision”. For a person to make a capable and logical decision within a situation they need to be properly educated. “Lack of education is too frequently mistaken for incapacity”. If there is a lack of education, then answers given within a certain situation will quite certainly look like incapable answers, when in fact, all the patient needed was relevant information. The fifth step in the ‘capacity assessment process’ is perhaps the most important. It is within this step that a person’s life will be changed. This is when “the assessment takes place”. The assessor will compile evidence that will determine whether a person is capable or not. In this step a patient’s autonomy can be denied or left alone, this decision is based on the opinion of one person and what he or she believes is ‘right’. The sixth and final step of the ‘capacity assessment process’ is “actions are taken depending on the results of the assessment”. Case 9.10 The Right to Die? “A twenty five year old patient suffered from a nerve disorder. It has left her paralyzed from the neck down and unable to breathe without the aid of a ventilator. After two years and no signs of improvement, the patient asked the doctor to discontinue the use of a ventilator, so that she might die. The doctors denied her request, and made her take it all the way to court. The court ruled in the patients favor and was taken off the ventilator.” This capacity assessment went in the patients favor and she was allowed to control her own destiny. She did not want to suffer any longer, and she was mentally sound from beginning to end, but the doctors felt they had the right to question her capacity, even though there was no valid trigger. The patient was of sound mind and she knew what the consequences of her actions would be and yet her physicians still tried to take away her fundamental right of free will. The ‘assessment capacity process’ directly affects the autonomy of a patient. To take away a part of a person’s free will or all of it entirely is an extremely serious decision. From a deontological approach autonomy should not be tampered with. It is a person’s fundamental ‘right’ whether they want to have surgery or not, or whether they want to eat or not, or whether they want to live or not. Capacity assessment is just a tool to control somebody’s life, it they are not living it to someone else’s standards. “Rooted in Kant’s Categorical Imperative, the notion of respect for autonomy imposes a moral obligation on the physician to treat others as “ends in themselves” and never as merely a means” . A physician should treat every patient as intrinsically valuable, not as just another ‘person’ that is sitting before them. The code of Medical Ethics states that, "A physician should not only be ready to obey the calls of the sick at all times, but his mind should be attuned to the greatness of his mission and its responsibilities. ” It is not the physician’s responsibility to do what he or she thinks is correct, but to do what is in the best interest of the patient. Essentially, the outcome of that decision is not what is most important, but that patient autonomy was the priority. If a person or patients wants to put themselves at risk, that is their own choice and it should not be questioned. However, when those choices are putting others at risk, and a valid trigger can be identified, then a capacity assessment should be performed. There are specific requirements that need to be evident for a valid trigger to be identified. There are five requirements that make up a valid trigger, “people have demons...