Decision-Making Capacityอ๊อฟ
One of the most difficult dilemmas is under what types of situations does the medical community and society at-large have a responsibility to override an adult person's wishes? For health care professionals, this issue is typically framed in terms of decision-making capacity, something that clinicians assess on a regular basis in both formal and informal ways (Dong &Gorbien, 2005). The presence or absence of capacity is often a determining factor in what the health care professionals, community, and society needs to do next. However, capacity is not often completely present or completely absent. It is a gradient relationship between the issues in question and older adult's ability to make these decisions. For complicated health issues, there is greater need to require higher levels of decisional capacity. At the same time, for simple issues, even a cognitive impaired adult could have decisional capacity. However, the health care provider is often forced to take a gray area and make it black or white for purposes of guiding next steps such as guardianship/conservatorship. Commonly used brief screening testing such as the MMSE is inadequate for determining capacity except at the extremes of the score. Tests useful in assessing decision-making capacity include the Hopkins Competency Assessment Test (Janofsky, McCarthy, &Folstein, 1992).