Abstract
Capacity is the ability to make decisions. Autonomy in decision-making and being safeguarded against abuse and undue influence are fundamental human rights. This chapter will demonstrate how “good” capacity assessment can support these human rights. The assessment of capacity is a complex and highly specialized task, governed by principles of the presumption of capacity, that capacity is not diagnosis bound, and the need for individualized, task-, and situation-specific assessments. The clinician engaged to undertake a capacity assessment has a responsibility to act as gatekeeper, and sometimes advocate, for the actualization of human rights. Capacity assessment presents opportunities to identify strengths and weaknesses to inform and enable supported decision-making. It also provides opportunities and obligations to identify abuse. When people with disability such as mental illness are empowered to make the decisions they are capable of making, while protected from making the decisions they are incapable of making, human rights are supported. Such principles are universal, regardless of the jurisdictional variations in the laws that govern capacity and competency determinations internationally.
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References
Appelbaum PS, Roth LH (1982) Competency to consent to research. Arch Gen Psychiatry 39:951–958
Ashdown B (2014) Legal capacity and case guardians- part 1. Legal capacity. Fam Law Rev 4(1):25. Accessed May 2016 http://www.academia.edu/7850956/Legal_Capacity_and_Case_Guardians_-_Part_1_Legal_Capacity
Australian Law Reform Commission (ALRC) (2014) Equality, capacity and disability in commonwealth laws. Discussion Paper 81. www.alrc.gov.au/sites/default/files/pdfs/publications/whole_dp81.pdf. Accessed online 25 May 2015
Bamford C, Bruce E (2000) Defining the outcomes of community care: the perspectives of older people with dementia and their carers. Ageing Soc 20:543–570
British Medical Association and The Law Society (2004) Assessment of mental capacity – guidance for doctors and lawyers, 2nd edn. BMJ Books, London
Browning M, Bigby C, Douglas J (2014) Supported decision making: understanding how its conceptual link to legal capacity is influencing the development of practice. Res Pract Intellect Dev Disabil. doi:10.1080/23297018.2014.902726
Clare L, Whitaker R, Woods RT, Quinn C, Jelley H, Hoare Z, Woods J, Downs M, Wilson BA (2013) AwareCare: a pilot randomized controlled trial of an awareness-based staff training intervention to improve quality of life for residents with severe dementia in long-term care settings. Int Psychogeriatr 25:128–139
Darzins P, Molloy DW, Strang D (eds) (2000) Who can decide? The six step capacity assessment process. Memory Australia, Adelaide
Davie V (1953) Lord provost, magistrates and councillors of the city of Edinburgh, SC 34 at 39–40
de Boer ME et al (2010) Advance directives in dementia: issues of validity and effectiveness. Int Psychogeriatr 22:201–208
Fick D, Foreman M (2000) Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals. J Gerontol Nurs 26:30–40
Flynn E, Arstein-Kerslake A (2012) “Equal recognition before the law: exploring a support model of legal capacity” 10 March 2012, ‘Equality: are we there yet?’ The Kent Critical Law Society Conference at the University of Kent, Canterbury, p 1
Friedlander MM, Brayman Y, Breitbart WS (2004) Delirium in palliative care. Oncology 18:1541–1551
Frost M, Lawson S, Jacoby R (2015) Testamentary Capacity Law Practice and Medicine. Oxford, Oxford University Press
Griffith HR, Belue K, Sicola A et al (2003) Impaired financial abilities in mild cognitive impairment. Neurology 60:449–457
Grisso T, Appelbaum PS (1995) Comparison of standards for assessing patients’ capacities to make treatment decisions. Am J Psychiatry 152(7):1033–1037
Grisso T, Appelbaum PS, Hill-Fotouhi C (1997) The MacCAT-T: a clinical tool to assess patients’ capacities to make treatment decisions. Psychiatr Serv 48(11):1415–1419
Hepner IJ, Woodward MN, Stewart J (2014) Giving the vulnerable a voice in the criminal justice system: the use of intermediaries with individuals with intellectual disability. Psychiatry Psychol Law. doi:10.1080/13218719.2014.960032
Hertogh CMPM (2011) The misleading simplicity of advance directives. Int Psychogeriatr 23:511–515
Hertogh CMPM (2015) Capacity and awareness: how to include people with decision making disability second international conference on capacity. IPA Congress, Berlin
Hooper SC et al (1997) Preferences for voluntary euthanasia during major depression and following improvement in an elderly population. Aust J Ageing 16(1):3–7
Inouye SK, Foreman MD, Mion LC, Katz KH, Cooney LM Jr (2001) Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med 161:2467–2473
Katona C, Chiu E, Adelman S, Baloyannis, Camus V, Firmino H, Gove D, Ghebrehiwet T, Graham N, Icelli I, Ihl R, Kalasic A, Leszek L, Kim S, Lima C d M, Peisah C, Tataru N, Warner J (2009) World psychiatric association section of old age psychiatry consensus conference on ethics and capacity in old people with mental disorders. Int J Geriatr Psychopharmacol 24:1319–1324
Kershaw MM, Webber LS (2008) Assessment of financial competence. Psychiatry Psychol Law 15:40–55
Kim SYH, Appelbaum PS (2006) The capacity to appoint a proxy and the possibility of concurrent proxy directives. Behav Sci Law 24:469–478
Kim SY, Karlawish JH, Kim HM, Wall IF, Bozoki AC, Appelbaum PS (2011a) Preservation of the capacity to appoint a proxy decision maker: implications for dementia research. Arch Gen Psychiatry 68(2):214–220
Kim SYH, Appelbaum PS, Kim HM et al (2011b) Variability of judgments of capacity: experience of capacity evaluators in a study of research consent capacity. Psychosomatics 52:346–353
Kolva EA, Rosenfeld B (2012) In: Demakis GJ (ed) Civil capacities in clinical neuropsychology. Oxford University Press, New York, pp 17–36
Lawton LJ in R v Turner [1975] QB 834 at 840
Leonard M, Donnelly S, Conroy M, Trzepacz P, Meagher DJ (2011) Phenomenological and neuropsychological profile across motor variants of delirium in a palliative care unit. J Neuropsychiatr Clin Neurosci 23:180–188
Levene I, Parker M (2011) Prevalence of depression in granted and refused requests for euthanasia and assisted suicide: a systematic review. J Med Ethics 37:205–211
Liptzin, B. Peisah C., Shulman K. Finkel S. for the International Psychogeriatric Association Task Force on Wills and Testamentary Capacity (2010) Testamentary capacity and delirium. Int Psychogeriatr 22:950–956
Makita (Australia) Pty Ltd v Sprowles (2001) 52 NSWLR 705, [at 743–744]
Mason S, Barrow H, Phillips A et al (2006) Brief report on the experience of using proxy consent for incapacitated adults. J Med Ethics 32:61–62
Massie MJ, Holland J, Glass E (1983) Delirium in terminally ill cancer patients. Am J Psychiatr 140:1048–1050
McDougall, R. Expert evidence http://www.supremecourt.justice.nsw.gov.au/Documents/mcdougall_2004.02.13.pdf. Accessed 1 April 2016
Meagher DJ et al (2007) Phenomenology of delirium. Assessment of 100 adult cases using standardised measures. Br J Psychiatry 190:135–141
O’Neill N., Peisah C (2017) Capacity and the law (2nd Edition), Australasian Legal Information Institute (AustLII) Communities. Available at http://austlii.community/wiki/Books/CapacityAndTheLaw/
Peisah C (2005) Reflections on changes in defining testamentary capacity. Int Psychogeriatr 17(4):709–712
Peisah C, Forlenza O, Chiu E. (2009a) Ethics, capacity, and decision-making in the practice of old age psychiatry: an emerging dialogue. Curr Opin Psychiatry 22(6):519–521
Peisah C., Finkel S., Shulman K., Melding P., Luxenberg J., Heinik J., Jacoby R., Reisberg B., Stoppe G., Barker A., Firmino H., Bennett H. for the International Psychogeriatric Association Task Force on Wills and Undue Influence (2009b) The wills of older persons: risk factors for undue influence. Int Psychogeriatr 21(1):7–15
Peisah C, Vollmer-Conna, SYH K (2012) Capacity to consent to research. Asia-Pac Psychiatry 4:219–227
Peisah C, Sorinmadeayo D, Mitchell L, Hertogh C (2013) Decisional capacity: towards an inclusionary approach. Int Psychogeriatr Assoc Task Force Capacit Int Psychogeriatr 25(10):1571–1579
Peisah C, Tiwana R, Benbow SM (2014a) Sexual expression, consent and capacity in residential care: a person-centered, human rights approach. In: Book of proceedings of the 1st annual international capacity conference. http://capacityaustralia.org.au/wp-content/uploads/2014/10/printed-Hong-kong-Booklet.pdf
Peisah C, Luxenberg J, Liptzin B, Wand A, Shulman K, Finkel S (2014b) Death bed wills: assessing testamentary capacity in the dying patient. Int Psychogeriatr Assoc Task Force Capacit (Int Psychogeriatr) 26(2):209–216
Resnick B, Gruber –Baldini A.L, Pretzer-Aboff, Galik E Custis Buie V, Russ K, Zimmerman S. (2007) Reliability and validity of the evaluation to sign consent measure. The Gerontol 47:69–77
Quinn G (2010) Personhood and legal capacity perspectives on the paradigm shift of article 12 CRPD HPOD Conference Harvard Law School
Ryan C, Callaghan S, Peisah C (2015) Assessing capacity to refuse psychiatric treatment: a guide for clinicians and tribunal members. Aust N Z J Psychiatry 49(4):324–333
Sabat S (2005) Capacity for decision making in Alzheimer’s disease: selfhood, positioning and semiotic people. Aust N Z J Psychiatry 39:1030–1035
Shulman KI, Cohen CA, Hull I (2005) Psychiatric issues in retrospective challenges of testamentary capacity. Int J Geriatr Psychiatry 20(1):63–69
Shulman KI, Cohen CA, Kirsh FC, Hull IM, Champine PR (2007) Assessment of testamentary capacity and vulnerability to undue influence. Am J Psychiatr 164:722–727
Shulman KI, Peisah C, Jacoby R, Finkel S et al (2009) Contemporaneous assessment of testamentary capacity. A consensus report from the IPA task force on testamentary capacity and undue influence. Int Psychogeriatr 21(3):433–439
Shulman KI, Himel SG, Hull IM, Peisah C, Amodeo S, Barnes C (2017) Banks v Goodfellow 1870: time to update the test for testamentary capacity. Can Bar Rev (in press)
Sinyor M, Schaffer AM, Hull I, Peisah C, Shulman K (2015) Last will and testaments in a large sample of suicide notes: implications for testamentary capacity. Br J Psychiatry 206(1):72–76
Sousa LB, Simões MR, Firmino H, Peisah C (2014) Financial and testamentary capacity evaluations: procedures and assessment instruments underneath a functional approach. Int Psychogeriatr 26(2):217–228
Stewart S, Woodward M, Hepner I (2015) Fitness to stand trial, human rights and possibilities from England and Wales. J Law Med 22(4):886–899
Tsoh J, Peisah C, Narumuto J, Masaru Mimura M, Wongpakaran N, Kato (2015) Cross national comparisons of substitute decision making across. Asia Aust Int Psychogeriatr 27(6):1029–1037
Tulsky JA (2005) Beyond advance directives: importance of communication skills at the end of life. JAMA 294:359–365
United Nations Treaty Collection (2016) https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-15&chapter=4&lang=en. Accessed Mar 2016
Voyer P, Richard S, Doucet L, Danjou C, Carmichael PH (2008) Detection of delirium by nurses among long-term care residents with dementia. BMC Nurs 7:4
Wiese M, Dew A, Stancliffe RJ, Howarth G, Balandin S (2013) ‘If and when?’: the beliefs and experiences of community living staff in supporting older people with intellectual disability to know about dying. J Intellect Disabil Res 57(10):980–992
Wiese M, Stancliffe RJ, Dew A, Balandin S, Howarth G (2014) What is talked about? Community living staff experiences of talking with older people with intellectual disability about dying and death. J Intellect Disabil Res 58(7):679–690
Wiese M, Stancliffe RJ, Read S, Jeltes G, Clayton JM (2015) Learning about dying, death, and end-of-life planning: current issues informing future actions. J Intellect Develop Disabil. doi:10.3109/13668250.2014.998183
Wood S, O’Bryan M (2012) In: Demakis GJ (ed) Civil capacities in clinical neuropsychology. Oxford University Press, New York, pp 185–205
Zuscak SJ, Peisah C, Ferguson A (2015) A collaborative approach to supporting communication in the assessment of decision-making capacity. Disabil Rehabil 12:1–8. epub ahead of print
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Peisah, C. (2016). Capacity Assessment. In: Chiu, H., Shulman, K. (eds) Mental Health and Illness of the Elderly. Mental Health and Illness Worldwide. Springer, Singapore. https://doi.org/10.1007/978-981-10-0370-7_17-1
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