Civil Competencies Flashcards
components of incompetence
- The person has a MENTAL disease.
- The disease causes a DEFECT in judgement.
- The defect in judgement causes a SPECIFIC INCAPACITY.
burden of proof in civil incompetence
Adults are presumed competent until proven otherwise, so burden of proof is on person proving incompetence.
components of testamentary capacity
The testator must generally understand:
- That he is writing a will.
- The extent of his bounty (property).
- Those who have natural claims upon his bounty.
undue influence on wills
Pressure applied unfairly to benefit another. Requires an element of coercion, compulsion, or restraint such that the will does not represent the wishes of the testator.
May negate a will even though the testator had testamentary capacity.
types of guardians
guardian of person (plenary)
guardian of the estate (conservator)
case re: competence to make medical decisions: capacity to consent to voluntary psychiatric hospitalization
Zinermon v Burch, USSC 1990. “The very nature of mental illness makes it foreseeable that a person needing MH care will be unable to understand…”
Court suggests in dicta that there should be procedures to screen competence for voluntary admission.
cases re: competence to make medical decisions: capacity to give informed consent
Evolving standards.
Physician-centered: Reasonable medical practitioner standard (Natanson v Kline, 1960)
Patient-centered: Materiality of the information standard (Canterbury v Spence, 1972)
case re: competence to consent to research
Kaimowitz v Michigan DMH, 1973.
Inherently coercive institutional environment prevents voluntary consent. Led to heavy restrictions on prison research.
cases re: models of alternative decision-making
Hargrave v Vermont, 2003: Vermont Act discriminated against mentally disabled in violation of ADA and Rehab Act of 1983. Statute precluded only mentally disabled who become incompetent from enacting DPOA.
Superintendent of Belchertown v Saikowicz, 1977: Profoundly ID man devel leukemia. Guardian recommended no tx 2/2 morbidity and terminal nature of disease. Holding: potentially life-prolonging tx requires substituted judgment. Decision must be what INDIVIDUAL would have wanted if competent.
Cruzan v director, Missouri DMH, 1990: Cruzan’s premorbid verbalization of her wishes was insufficient evidence to meet Clear and Convincing standard required by the State of MO to refuse life-sustaining nutrition and hydration; and clear & convincing standard was not unconstitutional.
2 things that can invalidate a will, even if the testator has testamentary capacity
“Insane delusions” or “undue influence”
Natanson v Kline
Supreme Court of Kansas 1960
Irma Natanson suffered burns after radiation tx for breast cancer.
Established REASONABLE MEDICAL PRACTITIONER standard.
Canterbury v Spence
DC Circuit Ct of Appeals 1972
Canterbury had laminectomy, paralized and incompetent.
Established MATERIALITY OF THE INFORMATION / REASONABLE PERSON standard.
Truman v Thomas
California Supreme Court 1980
Truman refused pap smears, died of cancer, kids sued.
Informed consent requires discussion of RISKS OF REFUSING TX.
Therapeutic misconception
The tendency for research subjects to believe the research is for therapeutic purposes (ie, for the gain of the subject) rather than designed to answer a larger study question.
Kaimowitz v Michigan DMH
Michigan Circuit Court, Wayne County, 1973.
“A person involuntarily detained cannot give consent to an innovative or experimental surgical procedure on the brain where the danger is high and the risks incapable of assessment.”
Involuntary pts live in inherently coercive environments.
This case led to nationwide modifications in criminal sexual psychopath detention w/o trial and curbed intrusive and risky institutional experimentation.
Hargrave v Vermont
2nd Circuit Court of Appeals
Nancy Hargrave had DPOA saying no psychotropics. VT had statute that allowed pts to be medicated against their will after a waiting period of 45 days.
Court found VT statute to be violation of ADA.
Superintendent of Belchertown v Saikowitz
Mass. Supreme Court 1977
Joseph Saikowitz, severe ID, leukemia.
Judge should apply SUBSTITUTED JUDGMENT DOCTRINE, defining sub judg as THE DECISION THAT THE INCOMPETENT PERSON WOULD HAVE MADE IF HE OR SHE WERE COMPETENT.
Cruzan v Director, Missouri DMH
USSC 1990
Nancy Cruzan in persistent vegetative state s/p MVA. Parents wanted to terminate life sustaining nutrition.
USSC held that Missouri’s requirement that evidence of incompetent person’s wishes meet standard of Clear and Convincing evidence was NOT unconstitutional.
APA Task Force on Consent to Voluntary Hospitalization (1993) recommendation re: minimal standard for capacity to consent to voluntary hospitalization
- Understand that he or she is entering a hospital.
- Understand he or she may not be able to leave if there were concerns about his or her risk of harm to self or others.
Final Report of the National College of Probate Judges Advisory Committee on Interstate Guardianships (1998)
Recommended facilitating the “portability” of interstate guardianships to facilitate moving guardianships across state lines to protect and further the best interests of the ward.
Competence to vote
Decided by the states.
One standard accepted in federal court is defined by a person’s capacity to understand the nature and effect of voting and the capacity to choose among the candidates and issues.
Incompetence to enter into a contract
It must be shown that a mental disability (incl cognitive disabilities) rendered the individual unable to appreciate the nature of the transaction or its ramifications.
Simple ignorance or lack of sophistication is NOT sufficient.
