Informed consent presumes what about the patient’s decision-making capacity?

• A. It presumes the patient has decision-making capacity
• B. It presumes the patient lacks decision-making capacity
• C. It presumes the patient must always have a surrogate
• D. It assumes patient cannot understand medical information

Answer: (A)

Informed consent rests on respecting patient autonomy, which means a valid consent requires the patient to be able to understand the information, appreciate the consequences, reason about treatment options, and communicate a choice. Because autonomy is the default, we start with the assumption that the patient has decision-making capacity. Only if there is clear evidence that capacity is lacking—due to factors like cognitive impairment, delirium, or impairment from substances—do clinicians involve a surrogate decision-maker or use advance directives. Capacity is also decision-specific and time-specific, so a patient may have capacity for some choices and not others, or capacity may change over time. So the best answer is that informed consent presumes the patient has decision-making capacity.