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. 2015 Mar-Apr;12(3-4):27–31.

TABLE 1.

Sample questions to assess medical capacity and decicion-making using the four- component model by Applebaum, et al.

ABILITIES SAMPLE QUESTIONS
Expression of choice

  • 1. Which treatment would you prefer for your condition?

  • 2. What is most important to you regarding your treatment?
Understanding/comprehension

  • 1. What are the potential side effects of this research medication, as you understand?

  • 2. What are the potential benefits with this treatment?

  • 3. How many weeks would you be asked to take this research medication if you agree to participate in this research study?

  • 4. Will this research involve any blood tests?

  • 5. How could you obtain more information about the research procedures or your rights?
Appreciation

  • 1. In what way is treatment X similar/different to treatment Y?

  • 2. What are the available treatment options for your condition?

  • 3. What do you understand is the natural course of your condition, if not treated?

  • 4. Who will have access to your personal medical information?
Reasoning

  • 1. What are the main reasons that drove your decision to participate/not participate in this research study?

  • 2. What do you understand is the natural course of your condition, if not treated?

  • 3. What do you think are some likely outcomes if your condition remains untreated?