We discuss capacity assessment, patient autonomy, safety, and documentation.
Hosts:
Anne Levine, MD
Brian Gilberti, MD
Core EM - Emergency Medicine Podcast Episode 210: Capacity Assessment
Jun 2, 2025
In this discussion, Anne Levine, a former chief resident and now a simulation fellow, teams up with Brian Gilberti to delve into the complexities of capacity assessment in emergency departments. They highlight the balance between patient autonomy and the ethical need for safety. Real-world examples, like intoxicated patients and those facing serious health decisions, showcase the nuanced decision-making involved. The conversation also unpacks the vital pillars of capacity assessment and the legal ramifications of failing to properly evaluate a patient's decision-making capability.
AI Snips
Chapters
Transcript
Episode notes
Balancing Autonomy and Safety
- Capacity assessment is crucial to balance patient safety with respecting autonomy in emergency medicine.
- It involves ethical decisions where forced treatment restricts a patient's rights and should be carefully considered.
Common ED Capacity Examples
- Intoxicated head trauma patients may refuse CTs but have unreliable exams and risk urgent injury.
- Elderly with sepsis might refuse admission due to caregiving duties, and diabetics may refuse surgery despite risks.
Framework for Capacity Assessment
- Evaluate capacity with four pillars: understanding, appreciation, reasoning, and choice.
- Use targeted questions to assess each pillar for clear decision-making capability.