Risk assessment as an integral aspect of capacity evaluations

Objective: To highlight the need for rehabilitation psychologists' evaluation of potential risks when examining an individual's decision-making capacity (DMC). Design: A literature review of research regarding decision making, predictive accuracy, and rehabilitation outcomes. Conclusions: The perceived level of risk or potential harm entailed in a decision determines the "sliding scale" for DMC. There is much less research on risk assessment than on the cognitive components needed for DMC, meaning that clinicians usually have to rely on clinical judgment. Clinical judgment is often inaccurate in terms of identifying factors that could increase the risk for harm and is susceptible to errors when predicting future risk. It is therefore argued that the process of assessing an individual's DMC must be matched by an equally rigorous analysis of clinicians' ability to quantify situational risk. Only when these 2 components are properly considered can an adequate standard for DMC be established.