How is decision-making capacity defined in end-of-life care, and how does it differ from general competence?

• A. Capacity is situation-specific and fluctuates; competence is a legal status determined by a court.
• B. Capacity is global and fixed; competence is a medical assessment.
• C. Capacity and competence are the same; both are always permanent.
• D. Capacity is determined by the patient; competence is determined by hospital policy.

Answer: (C)

Decision-making capacity is about a specific medical choice and can change over time. To determine capacity, you assess whether the patient can understand relevant information, appreciate the consequences for themselves, reason about options, and communicate a clear choice. Because illness, medications, or confusion can wax and wane, capacity is not fixed and may be present for some decisions and lacking for others or at different times.

Competence, on the other hand, is a legal determination about a person’s ability to manage their affairs in general. It is a broad status, usually decided by a court, and once established, is not something a clinician assesses for a single decision. In practice, when a patient is deemed to lack capacity for a specific end-of-life decision, surrogates or advance directives guide choices in line with the patient’s preferences. Capacity can improve if the underlying condition improves, whereas competence remains a legal status unless changed by a court.