Psychiatrymiddle twist
A 79-year-old woman with mild Alzheimer disease is an inpatient with a severe depressive episode. Electroconvulsive therapy is proposed. An hour after the discussion she repeats back accurately that it involves a general anaesthetic three times a week, that it can affect her memory, and that antidepressant medication is an alternative. Asked why she has chosen it, she says only that you are the doctor. She cannot say what might happen if she declined, or why she prefers it to tablets. Which one of the following elements of decision-making capacity is she failing?