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Complexity, Not Severity: Reinterpreting the Sliding Scale of Capacity

Published online by Cambridge University Press:  18 November 2022

George Mellgard  and
Nada Gligorov
George Mellgard
Affiliation:
Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York 10029, USA
Nada Gligorov*
Affiliation:
Alden March Bioethics Institute, Albany Medical College, Albany, New York 12208, USA
*
*Corresponding author. Email: gligorn@amc.edu
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Abstract

In this article, we focus on the definition and application of the sliding scale of capacity. We show that the current interpretations of the sliding scale confound distinct features of the medical decision, such as its urgency, its severity, or its complexity, that do not always covary. We propose that the threshold for assessing capacity should be adjusted based solely on the cognitive complexity of the decision at hand. We further suggest that the complexity of a decision should be identified based on a patient’s particular cognitive deficits. We utilize the current research on the types of deficits that characterize amnestic dementias and examine which types of medical decisions might be most complex for patients with that type of dementia. We conclude that applying the sliding scale based on individualized judgments of cognitive complexity will improve accuracy of assessment of capacity and enable capable patients to participate in medical decision making.

Keywords

capacitydementiacognitive complexitysliding scalemedical decisionscognitive deficits
Type
Research Article
Information
Cambridge Quarterly of Healthcare Ethics , Volume 31 , Issue 4 , October 2022 , pp. 506 - 517
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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Notes

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