A 70-year-old man with a gastrointestinal bleed and haemoglobin of 6 g/dL refuses blood transfusion. He correctly restates his diagnosis, the risks of refusing including death, the benefits of transfusion, and the available alternatives. He consistently maintains his refusal across two interviews and gives reasons based on long-held personal values. What is the correct assessment of his decision-making capacity regarding transfusion?

• A Absent, because refusal of life-saving treatment is irrational
• B Present only if a family member endorses his decision
• C Absent, unless a psychiatrist certifies him competent
• D Present, because he satisfies all four elements of capacity ✓

Explanation

Capacity requires four elements: ability to understand relevant information, appreciate its application to oneself, reason with the information, and communicate a consistent choice. This patient demonstrates all four, and capacity is decision-specific rather than global. Refusing a life-saving intervention is not by itself evidence of incapacity, and a competent adult may refuse any treatment even at the cost of his life. Family endorsement and mandatory psychiatric certification are not requirements.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.