Assessing Decisional Capacity: Ethics-Judgment & Clinical Guidelines
In Episode 1.7 of Psychiatry Boot Camp, we examine one of the most ethically challenging and clinically nuanced areas of psychiatry: decisional capacity assessment.
Whether you're in a hospital consult, outpatient setting, or long-term care facility, questions around a patient’s ability to make informed medical decisions arise frequently—and often in high-stakes situations.
To guide us through this essential topic, we welcome back Dr. Rajesh Tampi, a globally respected expert in geriatric psychiatry, Chair of Psychiatry at Creighton University, and Editor-in-Chief of the World Journal of Psychiatry. Dr. Tampi brings practical clarity and decades of experience to one of the most difficult judgment calls clinicians face.
🧠 In This Episode, You’ll Learn:
✔️ What decisional capacity is—and how it differs from competence
✔️ The four key elements of capacity assessment:
• Understanding
• Appreciation
• Reasoning
• Ability to communicate a choice
✔️ How to assess capacity in both medical and psychiatric settings
✔️ Strategies for working with patients who partially meet criteria
✔️ How to handle refusals of care and complex family dynamics
✔️ Common myths and legal misunderstandings
✔️ Documentation tips to support clinical and legal clarity
✔️ Geriatric considerations and cognitive impairment challenges
📌 Why Capacity Assessments Matter:
The ability to make informed decisions is a fundamental patient right—but when capacity is in question, clinicians must act with both clinical precision and ethical sensitivity. Poorly done assessments can lead to unnecessary guardianships or inappropriate autonomy.
This episode offers a structured, repeatable process for evaluating capacity while honoring the dignity, autonomy, and safety of patients.
Dr. Tampi emphasizes that capacity isn’t all or nothing—it’s task-specific, time-sensitive, and variable. His approach helps clinicians avoid overly rigid or overly lenient assessments and navigate complex cases with confidence.
👨⚕️ About Dr. Rajesh Tampi:
• Chair of Psychiatry, Creighton University
• Past President, American Association for Geriatric Psychiatry
• Editor-in-Chief, World Journal of Psychiatry
• National expert in geriatric mental health, cognitive disorders, and ethical decision-making
• Highly regarded teacher of psychiatry residents and interdisciplinary teams
🎯 Who Should Watch This Episode:
• Psychiatry and internal medicine residents
• Consult-liaison teams and hospitalists
• Geriatric psychiatrists and neurologists
• Psychologists, social workers, and ethics committee members
• Any clinician facing difficult treatment refusal or guardianship questions
This episode is especially valuable for those working in emergency, inpatient, hospice, or long-term care settings.
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💬 Discussion Starter:
Have you ever struggled with a capacity decision? How do you balance clinical judgment with ethical concerns? Share your stories and questions in the comments.
📌 Timestamps (Suggested Structure):
00:00 – Introduction to Decisional Capacity
02:40 – Legal vs. Clinical Definitions
05:15 – The Four Elements of Capacity
08:50 – Clinical Case Example
12:20 – Partial Capacity & Ambiguous Cases
16:30 – Documentation and Legal Implications
20:15 – Geriatric-Specific Considerations
23:00 – Final Advice from Dr. Tampi
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