Which statement best describes how capacity decisions should be approached when illness impacts decision-making?

• A. Assume capacity unless proven otherwise
• B. Re-assess capacity regularly and provide support to enable decision-making where possible
• C. Prohibit the person from making any decisions
• D. Always refer to external guardians for decisions

Answer: (B)

When illness affects decision-making, capacity isn’t something you just determine once and forget. It can change over time and vary by the specific decision. The best approach is to regularly reassess capacity and, whenever possible, provide support that helps the person participate in the decision. This means presenting information clearly, simplifying options, checking understanding, giving extra time, and enlisting trusted supporters to help interpret choices. The goal is to enable the person to make the decision themselves if they can, rather than defaulting to taking decisions away or referring to guardians immediately.

This approach balances respect for autonomy with protection, recognizing that with proper support and ongoing check-ins, many people can still contribute to decisions even when illness is present. Other options miss this balance: assuming capacity without ongoing evaluation, or prohibiting decisions altogether, or always turning to external guardians ignore the possibility of supported decision-making and the person’s ongoing wishes.