What indicates a patient may not have decision-making capacity?

• A. Being well-rested
• B. Intoxication, poisoning, hypoxia, closed head injuries, stroke, or psychiatric disease
• C. Normal orientation
• D. Stable mood

Answer: (B)

Decision-making capacity depends on the ability to understand information, appreciate its consequences, reason about options, and communicate a choice. When a patient is intoxicated, poisoned, hypoxic, has a closed head injury, stroke, or psychiatric illness, these conditions can disrupt attention, memory, and executive function, making it hard to grasp implications and foresee outcomes. That kind of impairment undermines capacity. In contrast, being well-rested, showing normal orientation, and having a stable mood suggest that cognitive and emotional processes needed for informed decision-making are intact, though capacity remains specific to the task and can change over time. So these acute states indicate a potential lack of decision-making capacity, whereas the other signs point toward preserved capacity.