How do capacity and competence differ in the context of consent?

• A. Capacity is a medical condition; competence is a financial status.
• B. Capacity is static and competence changes daily.
• C. Capacity is a functional, decision-specific assessable ability to understand information, appreciate consequences, reason about options, and communicate a choice; competence is a legal status judged by a court.
• D. Capacity only applies to adults; competence applies to minors.

Answer: (C)

The distinction hinges on how we think about a patient’s ability to consent. Capacity is a functional, decision-specific ability: it’s about whether a person can understand the information relevant to a medical option, appreciate the consequences of choosing or not choosing, reason about the options, and communicate a clear decision. Clinicians assess capacity in the moment for the particular decision at hand, and it can vary with the patient's condition or the complexity of the choice.

Competence, by contrast, is a legal status. It’s determined by a court and reflects whether a person has the mental capacity to make legal decisions across contexts. It’s not a medical diagnosis, is not typically something a clinician “decides,” and it may involve processes like guardianship if someone is found legally unable to manage affairs.

So, capacity is about actual ability to make a specific medical decision and can fluctuate, while competence is a legal judgment about overall decision-making ability. For example, a patient might have capacity to consent to a simple test but lack capacity for a complex surgical plan, in which case the clinician would assess capacity for that specific decision. A person may be deemed legally incompetent by a court for certain matters, which has legal implications, even though clinicians assess capacity clinically for medical consent.