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Who should document the decision-making process and basis for consent when the dependent has limited capacity?

The dependent should document it.

The guardian should document the decision-making process and basis for consent.

When someone has limited capacity, the guardian is the one responsible for recording how decisions were reached and the basis for consent. This documentation shows that choices were made in the dependent’s best interests, taking into account any known preferences, values, and available alternatives, and that the guardian considered the risks and benefits before giving or withholding consent. A written record also provides accountability, helps protect the dependent, and offers a clear trail for healthcare teams or future review to understand how decisions were made.

The dependent isn’t the appropriate person to document this when capacity is limited, because their ability to understand and reliably record the process may be impaired. No documentation misses critical accountability, and a neutral third party isn’t typically the standard approach unless a specific situation calls for it.

No documentation is necessary.

A neutral third party documents it.

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