Decisional Capacity and Competence

Slides:



Advertisements
Similar presentations
Why is it different? Disease of the mind affecting understanding and mental ability of the human being - disorder of attention concentration cognition.
Advertisements

What is Advance Care Planning?. Advance care planning “A process of discussion between an individual and their care providers irrespective of discipline.
ETHICS AND LAW Guidelines for treating people suffering from A.D. Ruth Goldberg.
2005. Why is it necessary When person lacks capacity physicians have power and influence over them which could be abused 30% pts on acute medical wards.
Decision Making Capacity Gary J. Gala, MD. Capacity Competency Clinical judgment Clinical judgment Can be assessed by any physician Can be assessed by.
DECISIONAL CAPACITY FEATURES STANDARDS TESTS AND CRITERIA.
Medical Ethics and Choice of Treatment or Determining decision making capacity – drawing clear lines in a murky sea of gray… James Hallenbeck, MD Director,
A presentation to the AABHL Conference Auckland, July 2012 Alison Douglass, Barrister Lynne Bowyer, Bioethics Centre, University of Otago A Douglass and.
Informed consent in research ethics
Legal Tests of Capacity Joanna K. Knowlton Deputy Public Trustee of Manitoba.
Legal aspects of palliative care Julian Gardner. Substitute decision-making Increasing in number – Ageing population – Incidence of dementia Increasing.
For consent to be valid: The patient must be competent – Mental capacity is decision-specific – Ability to understand, retain and weigh in the balance.
Abnormal Psychology Discuss to what extent biological, cognitive, and sociocultural factors influence abnormal behaviour Evaluate psychological research.
Who needs a Welfare Guardian? Sue Sue Gates Senor Researcher Donald Beasley Institute P O Box 6189 Dunedin.
Informed Consent: Requirements Ben Faneye, OP, DHCE West African Bioethics Training Program.
Consent and Confidentiality for Children in New Mexico Liz McGrath Executive Director Pegasus Legal Services for Children.
Competency Assessment. Competency and Capacity Capacity/Competency –Legal, clinical, ethical and social construct –“Ability of an individual to make autonomous.
Capacity Determination May 7 th, 2008 Alan Sanders, Ph.D. Director, Center for Ethics Saint Joseph’s Health System System Ethicist, Catholic Health East.
GARY HAIGH CAPACITY AND CONSENT. CONSENT Establishing consent is fundamental to respect for patients rights. It is a legal obligation.
INCOMPETENCY TO STAND TRIAL ART. 46B.003 Lacks rational and factual understanding of the proceedings Cannot consult with counsel Presumed competent Burden.
Informed Consent Sandra A. Price, JD Risk Manager WVU Health Sciences Center
Obtaining Informed Consent: 1. Elements Of Informed Consent 2. Essential Information For Prospective Participants 3. Obligation for investigators.
MPC §4.01  As a result of a mental disease or defect he or she lacked substantial capacity to: –Appreciate the criminality (wrongfulness) –Conform his.
Is Guardianship the Only Option? A Discussion about Guardianship and the Many Alternatives Hillary J. Dunn, Esq. Disability Law Center.
1 Consent for treatment A summary guide for health practitioners about obtaining consent for treatment Bridie Woolnough Resolution Officer Health Care.
Ethical Issues of Elder Care. Objectives Apply the concept of decision-specific capacity to older adults. Apply the concept of decision-specific capacity.
Assessment of Decision Making Capacity
Autonomy: Respect for Persons, Decision-making Capacity, & Informed Consent Walter Limehouse MD MUSC Ethics Committee Chair.
Thinking Ethically: Recognition and Approaches; Deliberations and Decisions Practice of Medicine I October 6, 2009 Walter Davis, M.D., M.A. Lois Shepherd,
The Competency Assessment Brian P. Skop, M.D. Forensic Psychiatric Consultant to University Health System Associate Clinical Professor of Psychiatry University.
Screening for Stroke and Cognitive Impairment Chapter 5: When is Cognitive Screening Limited?
Research with Vulnerable Populations Marisue Cody, PhD, RN IRB Chair Training Washington DC, April 9, 2004.
EPE C for VE T E R A N S EPE C for VE T E R A N S Education in Palliative and End-of-life Care for Veterans is a collaborative effort between the Department.
ASSESSING AN ADULT’S CAPACITY TO CONSENT.
1 Patients without Spokespersons Ethics Champions Program January 6, 2010 John F. Wallenhorst, Ph.D. Vice President, Mission & Ethics Bon Secours Health.
THE MENTAL CAPACITY ACT WHY THE ACT? No existing legal framework to protect incapacitated people Only safeguards relate to money & assets Incapacity.
Decision-Making Adam Burrows, MD Boston University Geriatrics Section Copyright Boston University Medical Center.
Vulnerable Populations Marisue Cody, PhD Deputy Director, PRIDE.
Decision Making at the End of Life Pain Fear Depression (SI) Isolation Cognitive loss Ethics Law Role of Psychiatrist Advance Directive SHC Guidelines.
Discussing an Ethics Case Walter Davis, MD Center for Biomedical Ethics Department of Physical Medicine and Rehabilitation University of Virginia.
Decision Making Capacity May 5 th, 2010 Alan Sanders, Ph.D. System Ethicist, Catholic Health East Director, Center for Ethics Saint Joseph’s Health System.
Diminished Mental Capacity Charlotta Eaton, MD Volunteer, Leadership Board Alzheimer’s Association Montana Chapter.
Consent & Vulnerable Adults Aim: To provide an opportunity for Primary Care Staff to explore issues related to consent & vulnerable adults.
Competency Assessing Decision Making Capacity Jeffrey J Kaufhold, MD FACP Chair, Bioethics Advisory Committee, Grandview Hospital.
Bridie Woolnough Resolution Officer Health Care Complaints Commission
JOE GULLETT COMPETENCY TO CONSENT TO RESEARCH AND TREATMENT.
By MUREREREHE Julienne BDT(Hons) KHI..  Informed consent is a legal document, prepared as an agreement for treatment, non-treatment, or for an invasive.
When is Cognitive Screening limited?. BRIEF COGNITIVE SCREENING: WHAT IT CAN DO I dentify possible cognitive deficits. Monitor changes in cognition over.
Decision-Making Capacity - under the medical model Dr. Michael A. Valente.
The Mental Health Act & Mental Capacity act Dr Faye Tarrant ST5 Substance Misuse.
Assessment of Patients’ Competence to Consent to Treatment Leon Driss MD, MMM.
THE INTERFACE BETWEEN SOCIAL WORK AND LAW Hospital social work and decision making capacity.
Independent Examination June 4, 2008 Jill Milloy, Ph.D. Independent Examiner Fairfax-Falls Church CSB.
Copyright © 2016 by Elsevier, Inc. All rights reserved. Common Legal and Ethical Issues.
Admission to secure dementia units – on who’s authority?
Medical Decision Making and Advance Care Planning
Jakub Zawiła-Niedźwiecki University of Warsaw
Capacity and Consent
Competency to Give an Informed Consent: A Model for Making Clinical Assessments James Drane.
Discussing an Ethics Case
Capacity vs. Competence Geriatric Interprofessional Training
Jamie Carlin Watson, Ph.D. University of Arkansas for Medical Sciences
How and When (Not) to Determine Decisional Capacity
Decision Making.
Decision-Making Capacity - under the medical model
Right to Die and Suicide Prevention in Older Populations
Jill Hanley, Public Administrator, St. Louis City
Competency Assessing Decision Making Capacity
Capacity Nancy Weintraub, MD, FACP Professor of Medicine, UCLA Director, UCLA Geriatric Medicine Fellowship Director, VA Special Advanced Fellowship in.
Right to Die and Suicide Prevention in Older Populations
Presentation transcript:

Decisional Capacity and Competence Walter S. Davis, MD Director of Education Center for Biomedical Ethics University of Virginia

Four Elements of Decisional Capacity (Applebaum and Grisso, 1995) Understanding Appreciation The ability to manipulate information rationally - reasoning The ability to communicate a choice

Decisional capacity The set of cognitive, volitional, and affective patient abilities that allows the physician to enter into the consent compact and ask the patient to make specific care decisions

Competence Best thought of as a legal concept Determination of competence/incompetence is done by court proceeding, and is usually done in the context of appointing a temporary (“ad litem”) or permanent guardian Medical “evidence” – either records or real-time testimony – is often presented

Four Functional Abilities in Decisional Capacity Assessment The ability to express a choice The ability to understand information relevant to treatment decision making The ability to appreciate the significance of that information for one’s own situation The ability to reason with relevant information to logically weigh treatment options

Expressing a Choice Legally a “threshold” issue Merely expressing a choice or preference does not indicate intact decisional capacity Clinical interpretation and examples: Depression Mental retardation Communication disorders

Understanding Most common functional ability used by courts to determine decisional capacity Psychologically and philosophically complex Related, in part, to a person’s level of intelligence Clinical interpretation and examples: Schizophrenia Major depression Medications Mental retardation

Appreciation Acknowledgement or appreciation that they suffer from the diagnosed disorder Acknowledgement of the consequences of the disease and the proposed treatment Clinical interpretation and examples: Denial Lack of insight depression

Reasoning Logically weighing options Clinical interpretation and examples: Problem focus Considering options Considering and imagining consequences Assessing likelihood of consequences Evaluating consequences based on one’s own subjective values Deliberating