Capacity vs Competence
How to tell Capacity and Competence apart when a board question makes them look alike.
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Capacity is determined by the treating clinician at bedside for one decision, while competence is determined by court order.
Side by side
Capacity is a bedside clinical judgment about a specific decision at a specific time.
Competence is a global legal status determined by a court, not by bedside clinicians.
Capacity depends on the patient's current ability to understand, appreciate, reason, and communicate a choice.
Competence reflects a judicial determination of legal decision authority across domains.
No lab test establishes capacity; clinicians document the four abilities and reassess after correcting reversible causes such as hypoxia, glucose derangement, intoxication, or delirium.
Competence requires legal adjudication records; hospital teams can provide documentation but cannot issue the legal ruling.
The trap
Teams wait for legal proceedings before urgent treatment decisions. If the patient lacks decision-specific capacity now, clinicians should identify a surrogate or use emergency implied consent while documenting the capacity assessment and reversible contributors.
The repair move
Next best step: perform and document a bedside capacity assessment for the immediate treatment decision, treat reversible delirium triggers, and if capacity is absent use surrogate consent or emergency implied consent as clinically indicated. Do not delay urgent care awaiting a court declaration of competence.
Try a free question
CoreA 63-year-old woman with diabetic foot sepsis refuses amputation but cannot explain the consequences of refusal and repeatedly changes her answer every minute. What is the next best step in management?
Show answer and explanation
Answer: A. Perform a bedside capacity assessment for this treatment decision. Capacity is a clinician-determined, decision-specific assessment and should be completed immediately in this situation.
Why the other choices are tempting
- B. Wrong. Competence rulings are legal and should not delay urgent bedside decision processes.
- C. Wrong. Adult status alone does not prove capacity.
- D. Wrong. Proceeding without assessment and documentation violates ethical and legal standards.
- E. Wrong. Psychiatry consultation may help, but medical team still must assess capacity for current decision.
Flashcards
Tap a card to flip it.
Who determines a hospitalized patient's capacity to refuse antibiotics today?
The treating clinician performs a decision-specific bedside assessment.
Which authority declares legal competence or incompetence?
A court, not the bedside medical team.
Quick answers
What is the fastest way to tell Capacity from Competence?
Capacity is determined by the treating clinician at bedside for one decision, while competence is determined by court order.
What is the key clue for Capacity?
Capacity is a bedside clinical judgment about a specific decision at a specific time.
What is the key clue for Competence?
Competence is a global legal status determined by a court, not by bedside clinicians.
What is the common trap with Capacity vs Competence?
Teams wait for legal proceedings before urgent treatment decisions. If the patient lacks decision-specific capacity now, clinicians should identify a surrogate or use emergency implied consent while documenting the capacity assessment and reversible contributors.