Comprehensive Assessments of Competence: A Psychiatrist’s Perspective

From the point of view of a geriatric psychiatrist who does assessments of competence, there are a number of essential elements to consider, as well as some more nuanced issues.

Let’s start with some core considerations: (1) competence is always presumed when the evidence is inconclusive; (2) competence is task- or decision- specific, such that assessments for each task or decision must be independent (for example, consent to treatment, refusal of treatment, choosing where to live, managing one’s finances oneself, executing a power of attorney or a mandate in case of incapacity, or making a will); (3) the recommended intervention should be the least restrictive of autonomy, while adequately protecting the patient. 

This article was published in the McGill Journal of Law and Health ~ Revue de droit et Santé de McGill, in 2011. The complete citation is:

Olders H. Comprehensive Assessments of Competence: A Psychiatrist’s Perspective. McGill Journal of Law and Health. 2011;5:283-286.

Download a pdf of the article here: Comprehensive Assessments of Competence: A Psychiatrist’s Perspective