The basic elements of a valid consent-the determi-nation that a patient has sufficient decisional capacity to consent or refuse treatment-are based on the ob¬servation of a specific set of abilities. In order to have decision-making capacity, the patient must be able to understand the relevant information, appreciate the situation and its consequences, reason about treatment options, and communicate a choice (Appelbaum, 2007). Applebaum notes that the use of standardized ques¬tions can increase the reliability of raters determining a patient’s capacity. He recommends the McArthur Competence Assessment Tool, which takes about 20 minutes to administer and score. However, he also suggests questions that are normally included when assessing each criterion to determine if a patient has the capacity to make a healthcare decision. Examples of the questions are as follows: