The situation can be further complicated by the urgent need for surgery. But in nonemergent situations, the anesthesiologist is ethically obliged to protect the rights of competent patients to make health care decisions for themselves. In considering a patient's capacity to make decisions, it is important to understand that capacity is relative and not absolute. Capacity is also task-specific. 1,2,4,5 Put simply, while a person may be competent to drive a car, it does not follow that the person can therefore fly an airplane.
Different tasks require different skills and levels of understanding.
A patient may be unable to tell you what day of the week it is and yet be perfectly capable of understanding why they need to have their broken arm repaired. In order to consent for or refuse care, patients must be able to receive and understand information relevant to their medical care, understand possible alternatives and consequences, communicate a choice and engage in reasonable discussion about their own values and desires in relationship to the physician's recommendations about treatment options. 1-6 Patients are not held to a level of understanding that approaches expertise, but they should be able to paraphrase information they have been given. Competence is not determined by the decisions that patients then make, and decisions in opposition to medical advice do not constitute proof or even the suggestion of incompetence. Further, decisions based on an unusual belief system, if consistent, do not constitute proof of mental illness.