Accreditation The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Designation Statement: The American Medical Directors Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
AMDCP Credit Designation: This session has been approved for a total of 1.5 Management credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).
Session Description: Challenges among staff in understanding the role of a surrogate decision-maker, the difference between competence and capacity, the presumption of competence, and how to quickly assess capacity for a particular situation were identified. Difficulties arose in four situations: 1) determining "what to write on the face sheet" and how to keep this updated, 2) assessment of whether a cognitively impaired person could engage in an unsafe or "unwise" activity, 3) refusal of care, and 4) dealing with conflicts between the wishes of cognitively impaired patients and their family members. In this session presenters will discuss a framework to evaluate capacity and show its utility in review of four cases.
Clarify the 'basics' of decision-making capacity and related issues, e.g., capacity vs. competence, the role of surrogate decision-makers, and balancing the rights of patients with our duty to protect and care for them.
Examine methods for assessment of capacity, and when a patient's rights may justifiably be restricted.
Discuss options available in LTC for enforcing limitations on patient actions in light of 'resident rights.'
Explore decision-making capacity as related to informed consent and refusal of care, especially when refusal may place the patient's health or life in jeopardy, if honored.
Speakers(s): Robert M. Gibson, PhD, JD; Rebecca Ferrini, MD, MPH, CMD, 2009 Medical Director of the Year
Disclosure(s): Robert M. Gibson, PhD, JD has no disclosures to report. Rebecca Ferrini, MD, MPH, CMD has no disclosures to report.
References: Grisso T., Appelbaum P.S.: Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals. New York, Oxford University Press, 1998.
MD, MPH, CMD,
County of San Diego, Health and Human Services, Edgemoor DP SNF