• G J Palacios, P Pinto, O Marquez, and B Herreros.
• Servicio de Medicina Interna, Hospital U. Fundación Hospital Alcorcón, Alcorcón, Madrid, España; Instituto de Ética Clínica Francisco Vallés, Universidad Europea de Madrid, Madrid, España. Electronic address: goyo.palacios1975@gmail.com.
• Rev Clin Esp. 2020 May 1; 220 (4): 256-262.

AbstractFor patients to be able to make decisions autonomously (and to grant informed consent), they must have information, understanding, freedom and willingness, with competence a prerequisite for autonomy. Clinicians are often faced with patients lacking competence to make decisions but detect less than half of such cases and often inadequately assess the patients' competence. This article offers guidelines for assessing the competence of patients for whom there are doubts about their ability to make decisions concerning their health. The procedure is based on 5 steps: 1) recognising the conditions that require a competence assessment; 2) fully evaluating the competence; 3) correlating the degree of competence with the complexity of the decision; 4) improving the patient's competence when possible; and 5) establishing who will make the decision.Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

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