Capable of more: some underemphasized aspects of capacity assessment

Background: The 4-abilities model of decision-making capacity is vulnerable to constricted application and teaching.

Objective: The authors attempt to assert the fundamentally clinical nature of capacity evaluations, while acknowledging that the concept of decision-making capacity must be legally grounded.

Methods: Relevant aspects of clinical care are examined and emphasized as they apply to the evaluation of capacity for medical decision making.

Results: Accessing patients' maximal abilities, attending to noncognitive aspects of choice, and identifying diagnostic explanations for patients' difficulties are important components of these assessments.

Discussion: The evaluation of medical decision-making capacity is not a purely forensic task; it is enhanced by an approach that bridges the clinical-forensic divide.