Etchells E, Sharpe G, Elliott C, Singer P A
University of Toronto Joint Centre for Bioethics, Department of Medicine, University of Toronto, Ont.
CMAJ. 1996 Sep 15;155(6):657-61.
In the context of patient consent, "capacity" refers to the patient's ability to understand information relevant to a treatment decision and to appreciate the reasonably foreseeable consequences of a decision or lack of decision. A person may be "capable" with respect to one decision but not with respect to another. Clinicians can usually identify patients who are clearly capable or incapable, but in some cases a clinical capacity assessment is required. Such assessment may consist of cognitive status testing, general impressions of capacity or specific capacity assessment. Specific capacity assessment, in which the clinician evaluates the patient's ability to understand pertinent information and appreciate its implications, is probably the optimal method. When conducting a specific capacity assessment, the clinician must ensure that the disclosure of information is effective and must evaluate the patient's reason for his or her decision. If the assessment suggests that the patient is incapable, further assessment is generally recommended.
在患者同意的背景下，“能力”指患者理解与治疗决策相关信息并认识到决策或不做决策可能产生的合理可预见后果的能力。一个人可能对某一决策有“能力”，但对另一决策则没有。临床医生通常能够识别出明显有能力或无能力的患者，但在某些情况下需要进行临床能力评估。这种评估可能包括认知状态测试、对能力的总体印象或特定能力评估。特定能力评估，即临床医生评估患者理解相关信息并认识其影响的能力，可能是最佳方法。进行特定能力评估时，临床医生必须确保信息披露有效，并必须评估患者做出决策的理由。如果评估表明患者无能力，一般建议进一步评估。
