“Competence” is primarily U.S. terminology and it has serious legal implications; in Canadianhealth care we use the term capacity instead. Specifically, in Canada, we ask if someone has“capacity to direct one’s own care.” Buchanan and Brock explain, capacity is simply the ability todo something or to make a particular type of decision at a particular moment in time.E.g. patients may have the capacity to decide what to have for lunch or where to stay when theyleave the hospital, but may not have the capacity to refuse kidney dialysis when their kidneysare failing.E.g. patients may have the capacity to direct their own health care in the morning, but not in theevening. This is called sundowning. Sundowning is late-day confusion of unknown cause, but isnot uncommon in dementing patients.Dementia is a very broad term used to describe a decline in thinking skills (e.g. memory,problem-solving, language) which affect one’s ability to perform activities of daily living likecooking, getting dressed, walking the dog.
