Decision-Making Capacity eLearning

What is Decision-Making Capacity?

Patients, their families, and caregivers may need to make decisions about their healthcare, living arrangements, finances and other areas if they experience a change to their health. When someone’s ability to make a decision is impaired, it makes them especially vulnerable. It’s important for care teams to identify this and to understand the process and protections that exist.

Healthcare providers need to consider if, when making a decision, an adult can: 

  • Take in key information,
  • Think about the pros and cons
  • Make a decision, based on his/her values

The learning series is for health care providers who do not have access to AHS or Covenant learning systems.  AHS and Covenant employees must complete this course through their internal tools. 

Please be aware of AHS’ Terms of Use before reviewing these resources.

Introduction | Legislation| Capacity Assessment Process| Role Clarity for Healthcare Providers| DMC Tools & Resources| Contact

Introduction to Decision-Making Capacity

eLearning Modules

Key Takeaways

Decision-Making Capacity

  • What it is: The ability to understand information and appreciate the reasonably foreseeable consequences of making (or not making) a decision
  • What it is not: Decision-making capacity is not a medical diagnosis or legal decision
  • Assessment of Capacity: A healthcare provider’s clinical opinion of an adult’s capacity based on evidence of impaired decision-making.
  • Default presumption: In Alberta, all adults are assumed to have decision-making capacity until proven otherwise.
  • Supportive approach: Always opt for the least restrictive support if someone's capacity is in question. Remember, losing capacity in one area does not mean it’s lost in all areas.

Planning Ahead

  • Why it’s important: Advanced planning means thinking about and recording wishes for personal and financial decisions in case they become seriously injured or ill.
  • When to plan: Before an injury or illness, while the person has capacity to decide.
  • Healthcare providers’ role: Help adults understand their options and the advanced planning documents they may need.

Further Learning & References

Legislation

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Key Takeaways

Legislation is law. Three key pieces of provincial legislation apply to decision making capacity:

  • The Personal Directives Act: allows an adult to name an agent for personal (non- financial) decisions
    • Key document: Personal Directive
    • Decisions: health decisions, living arrangements, legal matters, activities, etc.
  • The Powers of Attorney Act :allows an adult to appoint an attorney for financial decisions
    • Key Document: Enduring Power of Attorney,
    • Decisions: bill payment, bank access, property transactions, investments, donations, etc.
  • The Adult Guardianship and Trusteeship Act: applies where no advanced care planning is done and the person is unable to make decisions independently. Several decision-making options available to allow the least intrusive/least restrictive form of support for the adult.
    • Process for Guardianship/Trusteeship/Co-Decision Making: court determines the decision maker intending for the least restrictive support. 

Specific Decision Making: For urgent healthcare/accommodation decisions without a court order, if no guardian or personal directive exists. In addition to following capacity assessment process, there are additional processes when using Specific Decision Making (SDM) - review the SDM document below.

Further Learning & References

Capacity Assessment Process

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Key Takeaways

A three-part process for Decision Making Capacity Assessment (DMCA) is recommended:

  1. Screening –Identify Triggers for Questioning Capacity, Domains and Risks
  2. Problem Solving – a team approach to investigate a patient’s DMC with a focus on problem-solving and discovering options to reduce risk and possibly avoid a formal assessment
  3. Capacity Assessment – proceed with capacity interview (sometimes called capacity assessment) and determine if the adult has capacity to make the decision

Further Learning & References

Role Clarity for Healthcare Providers

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Key Takeaways

  • Several disciplines contribute to Decision Making Capacity Assessment (DMCA). Providers should review the information for all disciplines, not just their own. 
  • Any provider who has been designated as Capacity Assessors under the Adult Guardianship and Trusteeship Act by the Minister of Alberta Seniors and Community Supports should review information specific to that role.

Further Learning & References

All Providers

Social Workers

Physicians and Psychologists

Designated Capacity Assessors 

DMC Tools & Resources

eLearning Modules

Key Takeaways

Providers can use a suite of tools to complete the 3 parts of DMCA. Those follow the DMCA process described on the Capacity Assessment Process page:

  1. Screening
  2. Problem Solving
  3. Capacity Assessment

Further Learning & References

Contact

If you have questions about course content email practice.consultation@ahs.ca.