Resource Document on Decisional Capacity Determinations in Consultation-Liaison Psychiatry - A Guide for the General Psychiatrist

Sep 12, 2026

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Evidence-based guidance for general psychiatrists performing decisional capacity (DC) determinations in consultation-liaison settings. The document reviews classic and emerging DC literature, organized across nine topic areas aligned with conducting a DC case interview, and translates it into a standardized clinical methodology. It covers DC contexts such as consenting to accept or refuse recommended treatments, capacity to leave against medical advice, and capacity for discharge planning, emphasizing modifications of assessment techniques, use of standardized rating instruments, and literature-supported recommendations for each concern area.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages17

Reading Time6 min

AccessFree to download

Introduction

Scope and clinical contexts

Literature-informed approach

Organization of the nine topic areas

DC determination methodology

Determine the type of decisional DC question

APA Resource Document Resource Document on Decisional Capacity Determinations in Consultation-Liaison Psychiatry: A Guide for the General Psychiatrist Approved by the Joint Reference Committee, June 2019 "The findings, opinions, and conclusions of this report do not necessarily represent the views of the officers, trustees, or all members of the American Psychiatric Association. Views expressed are those of the authors. " --APA Operations Manual. Prepared by: James A. Bourgeois, OD, MD; Maria Tiamson-Kassab, MD; Kathleen A. Sheehan, MD; Diana Robinson, MD; Mira Zein, MD on behalf of the Council on Consultation-Liaison Psychiatry Introduction: Consultation-Liaison Psychiatrists are experienced in responding to requests from medical services for the determination of decisional capacity (DC) . General psychiatrists are occasionally called upon to perform decisional capacity determinations, especially when functioning in a consultation-liaison role. Some may not have extensive prior or current experience in decisional capacity determinations. In recent years, there has been a significant amount of clinical research literature on DC, particularly in a consultation-liaison clinical context. As such, having a review of the recent literature leading to an evidence-based, standardized approach to DC determinations is of pragmatic value to the general psychiatrist. The authors, all members of the APA Council on Consultation-Liaison Psychiatry, have reviewed the classic and emerging literature on DC in a consultation-liaison context, including clinical methodology, specific psychiatric and neurologic illnesses affecting DC, use of standardized rating instruments, and modification of clinical examination techniques for DC determinations. The authors of this resource document cover a sequence of nine topic areas pertinent to DC determinations, ordered in a way consistent with the conduct of a consultation-liaison interview of a DC case. In each section, there is a review of the relevant literature for that topic, yielding a literature-informed and comprehensive proposed clinical methodology for DC determinations in the context of consultationliaison psychiatric evaluations. The authors took this approach to DC to be a useful guide for general psychiatrists who have the occasional need to complete decisional capacity determinations when functioning in a consultation-liaison role. We emphasize that the scope of this document is to provide evidence-based guidance on the determination of decisional capacity in a consultation-liaison setting where the common context of DC determination varies among: 1. consent to accept recommended treatments; 2. consent to refuse recommended treatments; 3. capacity to be discharged from the hospital against medical advice (AMA); or 4. capacity to participate in discharge planning (recently referred to as dispositional capacity or capacity for abode) . In the consultation-liaison context, an additional type of decisional capacity determination is in the context of patient qualification for organ transplantation or major assistive device placement (e.g., left ventricular assist device (LVAD)) surgical procedures. This type of decision to accept a transplanted organ or an indefinite placement of a life-enhancing assistive device also involves a commitment to lifelong close medical follow-up and post-procedure clinical adherence. Due to the need for postprocedure adherence, this type of decision is more complex and “future oriented” than the “here and now” of decision making solely about a medical/surgical procedure. In such cases, routine application of the elements of standard decisional capacity determinations are supplemented by considerations of commitment to ongoing future care and adherence therewith. This particular type of decisional capacity assessment is not addressed in this document, as such consultations are typically accomplished by consultation-liaison psychiatrists as

FAQs

What is the purpose of this resource document for general psychiatrists?

It provides evidence-based guidance for general psychiatrists who occasionally perform decisional capacity determinations in a consultation-liaison role.

Which clinical decision contexts does the document focus on?

It emphasizes DC questions related to consent to accept recommended treatments, consent to refuse recommended treatments, capacity to leave the hospital against medical advice, and capacity to participate in discharge planning.

How is the material structured to support a consultation-liaison DC interview?

It reviews relevant literature for nine topic areas arranged to match the sequence of conducting a consultation-liaison interview, ending each section with recommendations for handling that element of the DC determination.

Sep 12, 2026

Upload by Sarah