• Marie-Yves Nadine Jean-Baptiste

What Defines a Person’s Mental Capacity for Deciding on Medical Treatments?

Updated: Oct 7, 2021

Mental capacity most often comes up in a conversation about the person who is infirmed, being able to make rational and informed decisions about the future progression of his or her care. The mental capacity of a person refers to the individual’s ability to make decisions regarding the person’s care, as opposed to having to assign another person or family member to make those decisions instead. In Maryland, a mentally competent adult is permitted to decide to have or not have a treatment, or consent or not consent to have a treatment whatever that treatment may be. A person can choose to have life-sustaining care or not, more treatments to prolong life or not, or live longer or not – as long as the individual is in his or her “right” mind.

Patient Mental Capacity and Understanding of Treatment Options

When we talk about mental capacity of an individual, it can be confusing to define the idea of if the person is competent or not. Usually, an individual being competent implies an understanding of what is happening to the person, that the person knows is taking place. For example, if a person is declared incompetent, that person by law is now unable to make decisions for himself or herself. But you have to look at the reasons for the incompetent status. Was the person of lowered mental capacity, has dementia or Alzheimer’s disease, or is the person a child, or was there a court order to any of these designations? Starting with adults, the law will assume that the person is competent and able to decide on how that person’s medical care should proceed. Therefore, you are competent until proven to be incompetent, in those cases.

The Finer Points of Healthcare Decision Making

All right, assuming that a person is competent to make his or her own health and medical care decisions, then when does this change to that same person not being able to do so, and being declared incapable of deciding on medical care actions?

The Maryland Health Care Decisions Act of 1993 states a person is competent unless determined to be incompetent or incapable of making informed decisions regarding care. The test used includes that a person needs to understand these three factors:

  1. The nature and likely outcomes of the treatment offered.

  2. The risks and benefits of the treatment offered.

  3. The ability to say out loud or communicate a decision that the treatment options presented are in fact understood by the person.

Let’s look at an example of how this would work in practice. Let’s take the example of Person A who has cancer, and who consults with her healthcare team regarding a new cancer treatment to treat her cancer. Person A in this case will likely be seen as competent to make the decisions regarding her care if she can repeat back the risks, understands the care plan and can decide whether to proceed or not with the new treatment.

Alternatively, let’s review the same scenario with Person B. Person B has the same cancer and is given the same consultation as Person A. If Person B when asked to repeat back her understanding of the care plan says, “Well, cancer is bad, and you know what to do to fix it,” Person B may be deemed incompetent to make the decisions to determine the course of her care.

Maryland Estate Planning Law Firm- The Saint Yves Law Firm

The mental capacity laws in Maryland are not meant to be confusing, but they often are and it is best to talk to a law office with attorneys who are knowledgeable on these issues if they apply to you or someone in your family. Schedule a consultation with our office, and let's start the conversation. We are here to help you to navigate these important issues to ensure that the necessary care is given to you or your loved ones right now.


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