Refusal Heuristics

Curbside to Bedside

Refusal Heuristic Traps:

How to avoid heuristic traps:

Competency Vs Capacity:

Competency is a global assessment and legal determination made by a judge in court. Capacity is a functional assessment and a clinical determination about a specific decision that can be made by any clinician familiar with a patient’s case.

How does a patient demonstrate capacity?

•Understanding – The ability to understand, i.e., knows the information being presented. Consider a patient who is having a COPD exacerbation, they know they have it, the treatment for it, and the benefits and risks of the treatment for COPD. •Expressing a choice – Can clearly communicate their choice when you present multiple options. A patient that frequently changes their choice (if they have some neurologic condition) could indicate they lack capacity. •Appreciation – They can apply the facts that you present to their own life and understands it’s relevance. If they do not acknowledge their illness or facts about their illness due to some delusions may lack capacity. •Reasoning – The ability to compare options and to infer consequences of a choice. Ask “How is not being transported to the hospital better than being transported”. This should illicit the patients values, which will require the patient to compare the consequences of what they want to do compared to what they do not want to do. References

Dastidar, J., 2011. How Do I Determine If My Patient Has Decision-Making Capacity?. [online] The-hospitalist.org. Available at: [Accessed 23 January 2021].

Karlawish, J., 2021. Uptodate. [online] Uptodate.com. Available at: [Accessed 23 January 2021].

McCammon, I., 2002. [online] Arc.lib.montana.edu. Available at: [Accessed 23 January 2021].

Selde, W., 2015. Know When And How Your Patient Can Legally Refuse Care - JEMS. [online] JEMS. Available at: [Accessed 23 January 2021].