How should capacity and autonomy be assessed when treating clients who may lack decision-making ability due to age, disability, or illness?

• A. Assume capacity in all cases.
• B. Obtain consent from guardians only, regardless of client's capacity.
• C. Assess understanding, voluntariness, and consequences; involve surrogates or guardians when appropriate; obtain consent only with capacity; document.
• D. Do not involve surrogates to preserve independence.

Answer: (C)

When assessing capacity and autonomy, the test hinges on evaluating whether the person can understand what is being proposed, make a voluntary choice, and grasp the consequences of that choice. For clients who may lack decision-making ability due to age, disability, or illness, you first determine if they truly understand the information about the treatment or decision, can appreciate how it affects them, and can reason through the options to reach a choice they express. If these elements are present, you obtain consent directly from the person. If they lack capacity for that decision, you involve surrogates or guardians to help protect the patient’s interests, following legal standards for substituted judgment or best interests, and you obtain consent through those surrogates. Throughout, you document the assessment, the rationale, who provided consent, and any advance directives, and you involve the patient to the greatest extent possible and reassess capacity as the situation changes. This approach respects autonomy whenever feasible while providing protection when capacity is absent.