All adults have the legal right to make informed decisions about their bodies and their health care. This includes the right to refuse care, even if the result is a shorter life.
Adults need to make their informed medical decisions after they:
- Learn about their health problems.
- Learn about the benefits and risks of available treatments.
- Discuss this information with their healthcare professionals.
There are two times when the usual way of getting permission for medical care might not work:
- In a real health emergency, it's understood that the adult or the person they picked to make choices (surrogate decision-maker) can't take too long and hurt the adult.
- Sometimes a court decides that the adult can't make their own medical choices.
Shared Decision-making
Under “shared decision-making”, the adult and the healthcare professional each use their knowledge to make healthcare decisions together.
The adult is the expert on their own values and their goals for care and treatment. The healthcare professional’s is the expert on figuring out a person’s illness and treatment options.
Shared decision-making means the adult and healthcare professional talk about the:
- Adult’s understanding of their health condition (diagnosis)
- Adult’s understanding of how severe the illness is, and how it can affect their health and wellbeing (prognosis)
- The reasonable treatment or healthcare options available
- Risks and benefits of possible tests and treatments
- Likely outcomes of each test or treatment
The adult can’t completely dictate their care. For example:
- Healthcare providers don’t have to order tests or give treatments that are useless or harmful.
- When the adult and the professionals disagree, they can discuss the options.
Decision-Making Ability
An adult’s ability to make decisions needs to be as broad as possible. For example:
- Even if an adult disagrees with the treatment their healthcare provider recommends, the adult can still make their own healthcare decisions.
- Going against a healthcare provider’s advice isn’t enough of a reason to question or assess someone’s ability to make healthcare decisions.
- If an adult can’t make decisions in one area, like finance, they still may have the ability to make decisions about their healthcare.
- Adults who have thinking or memory problems may still be able to make their own healthcare decisions.
- Adults may be able to regain their ability to make their own decisions in the future.
- A logical decision for one person might not seem logical to another. For example, an adult’s decisions often depends on their cultural, ethnic, or religious values and beliefs.
Healthcare workers need to respect these choices.
Adults who are unconscious or have severe mental health problems may not have the ability to make decisions. So, healthcare professionals sometimes need to find out whether an adult is able to make medical decisions.
There are several experts (including geriatricians, primary care physicians, psychiatrists, and psychologists) who can measure an adult's ability to make their own healthcare decisions.
When an adult doesn’t have the ability to make medical decisions, the healthcare team needs to find the person who has the responsibility for making those decisions.
Determining an Adult’s Ability to Make Decisions
Medical Decisions
Healthcare workers can learn about an adult's ability to make medical choices by: • Talking with the person about the decision, including the risks, benefits, and other options. The conversation should consider the adult's culture, education, and way of talking. The adult then tells the healthcare worker what they understood. This helps see if the adult knows what's going on.
- Finding out whether the adult understands how the medical decision will affect their body and brain.
- Finding out how well the adult uses the information and how consistent their decisions are over time.
- Checking whether the adult made a choice and kept this same choice over time.
Sometimes healthcare workers use regular tests to check an adult's mental state. But if a person doesn't do well on these tests, it doesn't always mean they can't make choices. These adults might need more help to understand the risks, benefits, and results of their medical decisions.
Adults who are in a coma, can't talk, or don't stay with a choice (when there's no new information) probably can't make decisions about their medical care.
When adults don’t have the ability to make decisions, they need help to do so. The healthcare professional needs to include this adult to the extent possible in decision-making about medical care.
Decisions about Self-Care
A healthcare professional can find out an adult’s ability to make decisions regarding self-care and living independently by finding out whether the person:
- Can care for themselves
- Has judgment and insight, including the ability to seek or accept the help they need to stay safe
Finances
A healthcare professional can find out whether an adult can make financial decisions based on whether they can:
- Pay bills
- Do math and keep track of money
Last Will and Testament
A healthcare professional can find out whether the adult has the ability to make decisions about a last will and testament based on their ability to:
- Ability to remember estate plans
- Tell the reasons behind choices
Advance Directives
A healthcare professional can help the adult:
- Complete advance directives, including a living will
- Appoint a trusted person to have the healthcare power of attorney so that person can make medical decisions when the adult can’t.
Last Updated May 2023