ASCO: You’re listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world’s leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In today’s podcast, Dr. Paul Appelbaum, Dr. Allison Magnuson, and Dr. Jonathan Marron, will discuss their article “Medical Decision-Making in Oncology for Patients Lacking Capacity,” from the 2020 ASCO Educational Book. They discuss what it means for someone to be unable to make significant medical decisions for themselves, known as “decisional capacity,” and offer practical tips for families and caregivers. Published annually, the Educational Book is a collection of articles written by ASCO Annual Meeting speakers and oncology experts. Each volume highlights the most compelling research and developments across the multidisciplinary fields of oncology. Dr. Paul Appelbaum is a psychiatrist at Columbia University Medical Center, where he researches decisional capacity and decision-making in medical contexts. Dr. Allison Magnuson is a geriatric oncologist at the University of Rochester, where she researches older adults with cancer and older adults with preexisting cognitive impairments. Dr. Jonathan Marron is a pediatric oncologist, bioethicist, and researcher at the Dana-Farber Cancer Institute and Boston Children's Hospital. View disclosures for Dr. Appelbaum, Dr. Magnuson, and Dr. Marron at Cancer.Net. Dr. Marron: Hi. We wanted to welcome you to this Cancer.Net podcast. Today we're going to discuss our article in the 2020 ASCO Educational Book which is entitled “Medical Decision-Making in Oncology for Patients Lacking Capacity.” What we hope to focus on today specifically is what this means for patients, for families, for caregivers, and provide some practical guidance not just for oncologists but for patients, families, and caregivers specifically. My name is Jonathan Marron. I am a pediatric oncologist, bioethicist, and researcher at the Dana-Farber Cancer Institute and Boston Children's Hospital. Dr. Appelbaum: And I'm Paul Appelbaum. I'm a psychiatrist at Columbia University Medical Center where I do research on, among other things, decisional capacity and decision making in medical contexts. Dr. Magnuson: And I'm Allison Magnuson. I'm a geriatric oncologist at the University of Rochester, and my research focuses in older adults with cancer and more specifically in older adults with preexisting cognitive impairments. Dr. Marron: We should point out that none of the 3 of us have any relevant conflicts to disclose. Dr. Applebaum, can you tell us a little bit about what capacity is and why it matters to patients and their families? Dr. Appelbaum: So capacity is both an ethical concept and a legal construct. And it refers to those decision-making abilities that we require people to have, in order to make decisions that are binding decisions, valid and worthy of respect by others. Over the years, this notion of decisional capacity has evolved in a more focused way. So it was once the case that people were considered to be capable of making all decisions or no decisions. And now we recognize that people may be capable of making some decisions but not others. Moreover, we recognize that this capacity taken as a whole can change over time. So if you're sick, in pain, anxious, or of course unconscious, you may lack capacity to make decisions at that point. But the following day, when you