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July 1996

Decision-Making Capacity

Author Affiliations

Extended Care Facility Harrisburg Polyclinic Medical Center 2601 N Third St Harrisburg, PA 17110

Arch Neurol. 1996;53(7):588-589. doi:10.1001/archneur.1996.00550070018004

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Marson et al1 have recognized that decisionmaking capacity (DMC) is task specific and that impairment of DMC can occur in degrees, rather than being all or nothing. In so doing they are in good company with nursing home clinicians,2-5 legal scholars,6,7 and ethicists.8,9

The prevalence of "limited DMC," intermediate between full DMC and none, was recently studied among residents of our hospital-based nursing home. Limited DMC was defined as demonstrating an inability to independently make 1 or more decisions in the civil, personal, financial, or health care domains while still showing the ability to recognize significant family members or others and designate them as power-of-attorney. A substantial number of residents fell in the limited DMC category, ranging from 17% in a long-stay unit to 40% in a short-stay postacute unit10 (Table). Such residents require assessment of capacity to make decisions on a caseby-case basis for

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