10 Things About Capacity and Consent

Most of us want to maintain our right to consent and the capacity to make decisions as long as possible. Dr. Jasneet Parmar, an associate professor in the Department of Family Medicine at the University of Alberta, tells us what we need to know.

1  |  Decision-making capacity, as defined by the Government of Alberta, is “the ability to understand the information that is relevant to the decision and to appreciate the reasonably foreseeable consequences” of making, or failing to make, the decision.

2  |  Adults are all assumed to have the capacity to make their own decisions until the contrary is declared.

3  |  If there is a genuine concern about your ability to make safe decisions, an assessment will be performed by a physician or psychologist (or a designated capacity assessor in special circumstances). 

4  |  Being diagnosed with symptoms of dementia does not automatically strip you of your capacity to make decisions. “There are people in our community with dementia making decisions with the support of their families,” Dr. Parmar says. 

5  |  Removing capacity changes your legal status, which is why decision-making capacity should be assessed if situations progress to the point where it’s absolutely necessary.

6  |  Making unwise decisions isn’t enough to remove capacity—a lack of understanding of the context and consequences of decisions must also be evident. “We assess capacity when a person is making a decision that’s putting them in harm’s way and they appear to have impaired decision-making capacity, but not when the person is clearly taking risks by choice,” Dr. Parmar says.

7  |  There are eight areas of authority when it comes to decision-making capacity: accommodation, health care, finances, choice of associates, social and leisure activities, personal legal matters, employment and education. Losing capacity in one area does not mean you’ll immediately lose it in others. 

8  |  If decision-making capacity is removed, decision-making power is passed over to the agent named in your personal directive (a legal document covering personal matters) or enduring power of attorney (covering financial matters).

9  |  It’s important to have those documents in order—once you lose your legal decision-making capacity you can no longer sign them and friends or family will have to seek out legal trusteeship or guardianship, which can be a lengthy process.

10 |  Let the agent named in your personal directive know what you envision for your future care so your wishes can be carried out accordingly.