A patient’s capacity to give informed consent or to leave the emergency department against medical advice is a topic of great relevance to emergency clinicians. This article discusses the difference between competence and capacity and highlights the four essential elements involved in the assessment of a patient’s capacity.

A multicenter, one-day prevalence, prospective, observational, double-blind study in 19 ICUs revealed that the decisionmaking capacity of ICU patients was widely overestimated by all clinicians as compared with a capacity score measured by the Mini-Mental Status Examination and the Aid to Capacity Evaluation.

In an observational study conducted at an academic medical center in London, researchers looked at factors involved in decision-making. The presumptive diagnosis of infection by the emergency department (ED) influenced decision-making by both medical and surgical admitting teams. Medical teams tended to use a multidisciplinary approach to antibiotic decision-making. Surgical teams often delegated antibiotic decision-making to the most junior members of the surgical team.