Evaluating patients for impaired medical decisional capacity: An overview of ethical and clinical issues

An impaired ability to make treatment decisions is commonplace but often overlooked among medical and psychiatric patients. Evaluation of a patient’s ability to meaningfully make treatment decisions is a complex exercise in clinical judgment, requiring careful attention to the effect of the patient’s symptoms and the contextual features of the specific decision at hand. This article is a broad overview of the ethical and clinical aspects of decisional capacity that every physician needs to be familiar with to negotiate this challenging aspect of medical practice.