Capacity is not a score, not a mental status exam, and not a verdict on a person. It is a structured conversation about this decision, at this hour, testing four abilities: understanding, appreciation, reasoning and expressing a choice. Rate each answer the person gives, make the call, then choose what happens next. Watch what the dial does when the person agrees with the team.
Case 1 of 4
Step 1 · Rate each ability from what the person actually said
Step 2 · Your call, for this decision, right now
Step 3 · What happens next
Rate what the person said, not whether you agree with the choice. An unwise decision made through an intact process is a capable decision.
The capacity dial
Impairment in any one ability can be enough to defeat capacity for that decision — and appreciation is the one most often lost in psychosis and in mania with poor insight.
What just happened
Start with case one.
Read the decision on the table, then rate each of the four answers as intact or impaired. The point of the bench is the gap between how a person sounds and what the four abilities actually show.
0
Abilities rated
0
Calls correct
0
Next steps right
Two words students swap
Competence
A legal status decided by a court. Adults are presumed competent until a judge rules otherwise; the finding is formal, appealable, and reaches contracts and property. No nurse and no physician declares a person incompetent.
Capacity
A clinical judgement at the bedside about one decision at one moment. It fluctuates and it is decision-specific — absent at 0300 during intoxication, intact the same afternoon for a different question.
Neither a diagnosis nor involuntary status establishes incapacity. A person on a 72-hour hold is presumed to have capacity until a specific assessment of a specific decision shows otherwise — and the same standard applies to the person who says yes.