Consists of three basic elements: (1) the possession of a set of values and goals necessary for evaluating different options; (2) the ability to communicate and understand information; and (3) the ability to reason and to deliberate about one’s choices. There are four levels of capacity: (1) the ability to communicate a choice; (2) the ability to understand information; (3) the ability to appreciate one’s personal situation; (4) the ability to weigh information in a rationally defensible way. A medical determination of incapacity should not be confused with the legal determination of competency. [Sources: President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Healthcare Decisions: A Report on the Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship (Washington, D.C.: U.S. Government Printing Office, 1982). Applebaum, PS and Grisso, T, "Assessing Patients’ Capacities to Consent to Treatment," New England Journal of Medicine 319 (1988): 1635.]
