Capacity Part Two: Voluntarism & Difficult Scenarios

Core IM

Assessment of decision-making capacity is a common issue in clinical medicine, and one that is conceptually complex and fraught with controversies (John, 2020).  Any physician responsible for a patient’s care can perform a capacity evaluation, however few may feel prepared to do so, as assessment methods are poorly standardized (Skelton, 2010).

In this episode of Core IM, the team discusses the basic concepts underlying the decision-making capacity – including understanding, reasoning, appreciation, and choice - and exploring the nuances of applying this understanding to clinical cases can help learners feel more confident in making these assessments or knowing when additional consultation with psychiatry or ethics is indicated.  Join us for Capacity Part Two: Voluntarism & Difficult Scenarios.

First, listen to the podcast. After listening, ACP members can take the CME/MOC quiz for free.


Up to 0.5 AMA PRA Category 1 Credits ™ and MOC Points
Expires July 22, 2023   active


Free to Members


Podcasts and Audio Content


Core IM

Welcome to Core IM, a virtual medical community! Core IM strives to empower its colleagues of all levels and backgrounds with clinically applicable information as well as inspire curiosity and critical thinking. Core IM promotes its mission through podcasts and other multimodal dialogues. ACP has teamed up with Core IM to offer continuing medical education, available exclusively to ACP members by completing the CME/MOC quiz.

  1. Informed consent: For a patient to give informed consent, they need to have (1) adequate information, (2) decisional capacity to make the given decision, (3) and voluntarism
  2. Voluntarism: A concept described by Dr. Laura Roberts that describes our ability to make authentic, uncoerced decisions that are in line with our values and identity.
  3. Voluntarism can be influenced by four components:
    1. Developmental factors
    2. Illness-related considerations
    3. Psychological issues and cultural and religious values
    4. External features and pressures
  4. There are a number of challenges that can arise during and after a capacity evaluation. The two discussed in this episode:

a. Uncooperative patients
b. Unrepresented patients

  1. Clinicians may find that capacity evaluations bring up a number of challenging emotions. The four discussed in this episode: 

a. When patients make “bad” choices
b. Physician Bias
c. Treatment over objection
d. Moral Distress


Jafar Al-Mondhiry, MD, MA - Content writer, interviewer, host, producer

Tamar Schiff, MD - Content writer, interviewer, host, producer

Margot Hedlin, MD - Content writer, interviewer, host, producer

Cynthia Geppert, MD, PhD - Guest Expert

Shreya Trivedi, MD - Producer, editor


Andrea Kondracke, MD

Anita Chang, DO

Those named above unless otherwise indicated have no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.

Release Date:  July 22, 2020

Expiration Date: July 22, 2023

CME Credit

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the Core IM.  The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.

The American College of Physicians designates each enduring material (podcast) for 0.5 AMA PRA Category 1 Credit™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Points

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.5 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.  Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

How to Claim CME Credit and MOC Points

After listening to the podcast, complete a brief multiple-choice question quiz. To claim CME credit and MOC points you must achieve a minimum passing score of 66%. You may take the quiz multiple times to achieve a passing score.