Can This Person Still Make Their Own Medical Decisions?
Being confused, forgetful, very ill, or hard to understand doesn’t automatically mean someone can no longer make medical decisions.
The question is about this decision, at this time.
Someone may need help with money, medications, or daily life and still be able to make some medical decisions. The ability to decide can also change as illness, medications, delirium, pain, or other conditions change.
Ask the Clinician Directly
Say:
“Can they still make this decision for themselves?”
Then ask:
- Who assessed that?
- When was it assessed?
- Was it about this decision or a different one?
- Is it documented in the chart?
- Could it change?
Ask before anyone signs or consents on the person’s behalf.
“She’s confused” and “she can’t make this decision” aren’t the same statement. Ask:
“Which one are you telling me?”
Find Out What Changed
Tell the care team what you’re seeing and when it started.
- Is this new, or has it been building?
- Does the confusion come and go?
- Did it start after a medication change, hospital stay, fall, procedure, or illness?
- Can the person explain what they want and why?
Confusion that comes on quickly or changes during the day can have a treatable cause. Illness, medication effects, dehydration, pain, low oxygen, sleep disruption, and other medical problems can affect thinking.
Before anyone assesses whether they can decide, make sure they have their glasses and hearing aids, and a medical interpreter if they need one.
Say:
“This is new. What are you checking for, and should their ability to make this decision be looked at again if the problem improves?”
Don’t let a temporary change become a permanent answer.
If They Can Still Decide
The decision belongs to them.
Family members may disagree. That doesn’t by itself take the decision away from the person.
A choice that other people think is unwise isn’t by itself proof that someone can’t decide. A person who can make the decision can refuse treatment others would accept.
They don’t have to make the decision other people think is best. They do need to be able to understand the decision, what could happen, and the choices in front of them well enough to make it.
If the person is being talked around or ignored, say:
“Can they make this decision? If they can, I want their decision documented and included in the plan.”
If the care team or the family keeps going around them, ask for the social worker, patient advocate, or a care-team meeting.
If family members are deciding what the person gets to know, use My Family Is Deciding What I Get to Know →
If They Can Decide Some Things and Not Others
This can happen.
Ask:
“Which decisions can they still make for themselves?”
Keep the person involved in every decision they can still make.
Even when someone else has to make the final decision, ask what the person wants and make sure the care team hears it.
If They Can’t Make This Decision Right Now
Ask who’s responsible for speaking for them.
- Is there an advance directive or medical power of attorney?
- Has someone been named to make medical decisions?
- If nobody was named, who does state law recognize?
- Is that person available?
- Is the decision-maker identified in the chart?
When no appointed decision-maker is available, states have different rules about who may serve as a default surrogate.
A spouse or adult child may have authority in some situations, but the priority and scope of that authority vary by state.
If you’re close to the person but not legal family, see I Am Not Legal Family →
Say:
“Who’s recognized as the decision-maker here, and where’s that documented?”
If a document exists, make sure the care team actually has it.
If there’s no clear decision-maker, ask the hospital, hospice, facility, or medical office social worker what process applies where you are.
If nobody is named and nobody obvious is available, use I Don’t Have Anyone to Speak for Me →
If you’re the person who has to decide and don’t know what they would want, use I Don’t Know What They Would Want →
If You’re Being Asked to Sign
Don’t assume that being family means you automatically have authority to sign.
Ask:
“What gives me the authority to make or sign this decision, and is that documented?”
The authority may come from an advance directive, another legal document, or state law.
If there’s a dispute about who has authority, use I Need Legal Help →
If You Think the Assessment Is Wrong
Ask for it to be looked at again.
Say:
“I don’t think this reflects how they usually are. Can the assessment be repeated, and can I tell you what I’m seeing?”
Tell the clinician if the person was unusually tired, in pain, recently medicated, just out of a procedure, or having confusion that comes and goes.
Ask:
“Who can reassess this, and should another clinician or specialist be involved?”
If the problem is disagreement about how the decision is being handled rather than the assessment itself, ask whether a patient advocate, social worker, care conference, or ethics consult can help.
Before Anyone Signs
Know:
- what decision is actually being made
- whether the person can make that decision now
- who assessed that and when
- whether it’s documented
- whether a temporary or treatable problem may be affecting them
- who has authority if the person can’t decide
- what the person says they want
Learn More
Information about informed consent, decision-making ability, how capacity can change, and when someone else may need to help make medical decisions.