Understanding capacity
The first principle of decision-making is that all adults are presumed to have capacity to make decisions for themselves. Intellectual or cognitive impairment, mental illness, brain injury, dementia, age and illness may impact on a person’s decision-making ability but it doesn’t necessarily mean they lack capacity.
Capacity is also a constant question. It can fluctuate or change, so therefore is decision-specific and time-specific. A person with dementia or delirium for example might have capacity on some days or during parts of the day.
Capacity should be presumed at each new decision.
Referring to a substitute decision maker should be the last resort. Everyone must be afforded the opportunity to participate in decisions about their life. This may require Supported Decision Making.
Capacity assessment
Generally, substitute decision making powers are only enacted if a person has been assessed as having impaired capacity. Evidence is required. This is done through a Capacity Assessment.
The Queensland Capacity Assessment Guidelines 2020 provide a guide to understanding capacity assessment and the legal tests of capacity under Queensland’s guardianship legislation.
General test of capacity
When considering a person’s capacity to make decision, look whether the person:
- Understands the nature and effect of the decision
- Can freely and voluntarily make the decision
- Can communicate the decision in some way
- Is assessed at the time a decision is required
Resources
Queensland Capacity Assessment Guidelines
Healthcare decision making: Key
principles for health practitioners
Your Life, Your Rights Flyer
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