Journal Review and Clinical Challenges in Surgical Palliative Care: Assessing Decision-Making Capacity

Join the University of Washington Surgical Palliative Care Team for their final episode of this series — a dual journal review and clinical challenges discussion on assessing medical decision-making capacity. Using Dr. Paul Applebaum’s foundational framework, the team outlines the four key criteria for evaluating capacity and brings the topic to life through two contrasting standardized patient scenarios. This episode highlights why capacity assessment is not only relevant but essential for surgeons navigating complex, high-stakes decisions.

Hosts:
Dr. Katie O’Connell (@katmo15) is an associate professor of surgery at the University of Washington. She is a trauma surgeon, palliative care physician, director of surgical palliative care, and founder of the Advance Care Planning for Surgery clinic at Harborview Medical Center, Seattle, WA.

Dr. Ali Haruta is an assistant professor of surgery at the University of Washington. She is a trauma and emergency general surgeon and palliative care physician. Ali recently completed fellowships in palliative care at the University of Washington and Trauma and Critical Care at Parkland.

Dr. Lindsay Dickerson (@lindsdickerson1) is a PGY6 general surgery resident at the University of Washington with an interest in surgical oncology.

Dr. Virginia Wang is a PGY3 general surgery resident at the University of Washington.

Learning Objectives:
1. Decipher the distinction between the terms “capacity” and “competence”.

2. Describe the four criteria for assessing medical decision-making capacity presented in Dr. Paul Applebaum’s article “Assessment of Patients’ Competence to Consent to Treatment.”

3. Apply the capacity assessment framework to real-world clinical scenarios in surgical practice.

References:
1. Applebaum, PS. Assessment of Patients’ Competence to Consent to Treatment. New England Journal of Medicine 2007; 357(18):1834-1840. https://pubmed.ncbi.nlm.nih.gov/17978292/

2. Special thank you to Mr. Mark Fox for his acting contribution to this episode.

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