Capacity vs Competence
How to tell Capacity and Competence apart when a board question makes them look alike.
Capacity: a clinical, decision-specific judgment made by a physician; competence: a global legal status determined by a court.
Side by side
Capacity is a clinical decision-specific assessment of understanding, appreciation, reasoning, and communication of a choice.
Competence is a legal determination made by a court regarding global decision-making authority.
Capacity is a clinical decision-specific assessment of understanding, appreciation, reasoning, and communication of a choice.
Competence is a legal determination made by a court regarding global decision-making authority.
Judged by a physician for one specific decision: understands, appreciates, reasons, and communicates a choice.
Legal, global determination made by a court; a guardian may be appointed.
The trap
Capacity is clinical and decision-specific; competence is legal and court-determined.
The repair move
Before naming the answer, force the stem through the separator: Capacity is clinical and decision-specific; competence is legal and court-determined.
Try a free question
CoreA 78-year-old man with mild dementia is hospitalized with pneumonia. The physician needs to decide whether the patient can consent to a chest tube placement. The physician evaluates whether the patient understands the procedure, can articulate the risks and benefits, can apply this to his own situation, and can express a consistent choice. Which assessment is being performed?
Show answer and explanation
Answer: A. Capacity assessment (clinical, decision-specific). CAPACITY is a CLINICAL determination by a physician for a SPECIFIC decision (DNR status, consenting to surgery, leaving against medical advice). Four elements: (1) UNDERSTAND relevant information, (2) APPRECIATE applying to one's own situation, (3) REASON through risks/benefits, (4) COMMUNICATE a consistent choice. Capacity is decision-specific (a patient may have capacity for simple decisions but not complex ones) and time-specific (may regain capacity when delirium resolves).
Why the other choices are tempting
- B. Competence is a LEGAL determination by a court for global decision-making.
- C. MMSE is a cognitive screen, not a capacity assessment.
- D. Mental status exam is broader than capacity.
- E. Beck Depression Inventory is for mood, not capacity.
Flashcards
Tap a card to flip it.
What clue supports Capacity?
Choose Capacity when the stem gives this pattern: Capacity is a clinical decision-specific assessment of understanding, appreciation, reasoning, and communication of a choice.
What clue supports Competence?
Choose Competence when the stem gives this contrasting pattern: Competence is a legal determination made by a court regarding global decision-making authority.
Quick answers
What is the fastest way to tell Capacity from Competence?
Capacity: a clinical, decision-specific judgment made by a physician; competence: a global legal status determined by a court.
What is the key clue for Capacity?
Capacity is a clinical decision-specific assessment of understanding, appreciation, reasoning, and communication of a choice.
What is the key clue for Competence?
Competence is a legal determination made by a court regarding global decision-making authority.
What is the common trap with Capacity vs Competence?
Capacity is clinical and decision-specific; competence is legal and court-determined.