If a physician doubts a patient's capacity to consent, which is possible?

• A. The physician must decide.
• B. The patient must decide.
• C. The patient regains capacity automatically.
• D. It may be the duty of the court to assume guardianship for non compos mentis.

Answer: (D)

Capacity to consent hinges on whether a patient can understand the relevant information, appreciate the consequences, reason about options, and communicate a choice. When a physician doubts whether the patient has that ability, it isn’t enough to declare incapacity or to appoint someone to decide for them on the spot. If the patient truly cannot understand and consent, and there is no valid advance directive or ready surrogate, the matter may need a legal determination. In such cases, the court can determine incapacity and, if appropriate, appoint a guardian to make medical decisions for the non compos mentis. This protects the patient’s interests and ensures decisions align with their known preferences or best interests when there’s no capable surrogate.

If a patient has capacity, they make the decision themselves. Capacity isn’t something guaranteed to magically appear; it requires actual assessment, and sometimes it can fluctuate, requiring reevaluation rather than an automatic change in status. A physician’s role is to assess capacity and provide information, not to unilaterally grant guardianship or override the patient’s rights.