When assessing capacity, which statement is most accurate?

• A. Capacity is global and does not vary by decision
• B. Capacity is decision-specific and time-specific, with re-assessment as needed
• C. Capacity should be assumed as long as the person is not actively ill
• D. Capacity is only relevant to medical decisions

Answer: (B)

Capacity to make decisions isn’t a single global trait. It depends on the specific decision at hand and the moment in time. For any given decision, you assess whether the person can understand the relevant information, appreciate the consequences, reason about options, and communicate a choice. These abilities can change with illness, medications, delirium, or other factors, so capacity should be evaluated for each decision and re-evaluated as circumstances evolve. This is why the statement describing capacity as decision-specific and time-specific, with re-assessment as needed, is the most accurate. The idea that capacity is global overlooks variation by decision; assuming capacity just because someone isn’t actively ill ignores potential fluctuations in cognition; and limiting capacity to medical decisions ignores decisions in finances, housing, and other areas that also require informed choices.