Q&A: Defining capacity and competence

Q: How can case managers better define and differentiate between a patient's capacity and a patient's competence?

A: The terms capacity and competence are often confused, if not used interchangeably. Each term has a distinct meaning and intent. Capacity involves a person’s ability to make informed decisions and provide informed consent. Can the client engage in a process to understand the purpose, consequences, or benefits of medical or surgical intervention or the requisite treatment? Informed consent is a vital part of any treatment effort. Is the client able to participate in the discharge planning process? Can the person understand the information and alternatives presented? Case managers may be asked by members of the treatment team if the patient is competent, when they actually want to know if the patient has capacity. Capacity involves attention to the following:

• Comprehension
• Free choice
• Reliability (or consistency)

Physicians can provide consultation and determine capacity; however, they cannot do so for competence.

Competence is a legal term and a process that speaks to determining the capability of a person to act on his or her own behalf or have the mental capacity to participate in legal proceedings or transactions (e.g., business, medical decisions). The term also refers to the mental condition a person mus have to be responsible for his or her decisions or actions (The Law Dictionary, 2018). Formal competency is traditionally determined by a judge, not by a case manager, physician, or psychiatrist.

For more information, see The Essential Guide to Interprofessional Ethics in Healthcare Case Management.