This worksheet may be of assistance in determining a person’s capacity to give informed consent. Capacity may vary among the different areas of a person's life; therefore, answer the questions in terms of the specific area in which his/her capacity is being determined (for example, one area might be "medical issues").
If all fourcriteriaare met, the person has capacity to give informed consent.
“…correct and sufficient information…”
Describe how this person receives information:
______
______
Are the appropriate methods being used to communicate to the person? Yes No
If “Yes”, which methods have been used?
______
______
If “No”, try other methods before assessing the person’s capacity to give consent.
CRITERIA FOR “CORRECT AND SUFFICIENT INFORMATION” IS MET
“…express…”
Describe how this person expresses information:
______
______
Does the person communicate an understanding of information provided to him or her, decisions he or she has made, and the reasons for those decisions? Yes No
If “Yes”, give an example.
If “No”, what evidence is there that the person cannot or does not communicate these things?
Evidence: ______
______
CRITERIA FOR “EXPRESS” IS MET
“…informed…”
Does the person demonstrate an understandingof the purpose, risks and benefits of any given action and its alternatives? Yes No
If “Yes”, give an example of the most complex situation in which this was demonstrated.
If “No”, is there evidence? Has the person ever had the opportunity?
Example/Evidence: ______
______
Do you feel comfortable relying on the person's ability to consent to
some matters without assistance from others? Yes No
Why or why not? ______
______
CRITERIA FOR “INFORMED” IS MET
“…voluntary…”
Does the person seek out the assistance of others for problem solving or decision- making? Yes No
If “Yes”, describe a situation in which this happened.
If “No”, does the person consider the advice of others when offered?
Prompt: If the person cannot make some informed decisions (as we all can’t about many things), it is acceptable to simply seek help, or to take the advice of others into consideration.
Evidence: ______
______
Can the person give consent of his own volition and free will, without undue influence and without perceived coercion from others?
Yes No
If “Yes”, describe a situation in which that happened.
If “No”, what evidence is there to suggest that the person cannot?
Prompt: “Perceived” coercion may occur when a person interprets what is intended to be advice to actually be a directive because he doesn’t feel empowered to make his own decisions or he’s eager to please those he’s dependent upon.
Explain: ______
______
CRITERIA FOR “VOLUNTARY” IS MET
If all four criteria are met, the person has capacity to give informed consent.
Revised 10/16/08