Mental Competency Flashcards
Mental capacity is defined as a…
Clinical status established by a healthcare professional
True or false. Capacity may change over time.
True
Mental competency is define as a…
Legal status judged by a legal professional
True or false. Mental competency is not situation specific.
False.
True or false. Someone may be competent to make financial, but not medical decisions.
True.
What do you need for consent?
- Must be voluntary
- Must have mental capacity
- Must be properly informed
What should be part of the assessment for mental competency and capacity?
- Standardized screening tests for cognitive decline
- Clinical interview
- Collateral information
- Further functional assessments
How do you assess capacity and competence during a clinical interview?
The patient must understand the information relevant to the decision.
The patient must appreciate the reasonably foreseeable consequences of a decision.
The patient must be able to communicate their decision by talking more by any other means.
In the case of a patient who is not competent to make a medical decision, how should you proceed?
Check the advance care directive.
In the event that an advance care directive is not available, a substitute decision-maker must be assigned.
List by hierarchy the substitute decision-makers
Guardian appointed by the court
Power of attorney for personal care
Representative appointed by consent and capacity ford
Spouse, common-law spouse or partner
Child (if over 16 years old)or parent (custodial)
Parent with right of access only
Brother or sister
Any other relative
Officer of the Public Guardian and trustee
In a patient with subtle symptoms or signs of cognitive decline what should you assess?
Mental competency and capacity
You are seeing a 80-year-old male with dementia. During the interview, he cannot complete three word recall at five minutes. Is he capable of making a medical decision?
The patient lacks a cognitive ability to remember the information long enough to make the decision.
You are seeing a 75-year-old woman with a diagnosis of delirium secondary to femoral fracture. She is alert but disoriented to time and place. She says that she understands that her hip is broken. She says that she is young and healthy, that she will definitely survive the surgery and there will be no complications. Why is she not capable of making the medical decision?
Although she understands her condition, she is unable to appreciate the reasonably foreseeable consequences of surgery.
A 25-year-old female comes in after a motor vehicle accident; her GCS is nine. She has two living relatives her sister who is 21 and her aunt. Who should be her substitute decision-maker?
Her sister
A 55-year-old male Which frontotemporal dementia presents to the emergency department with his partner of 15 years and his mother and father. He was deemed incompetent to make medical decisions. He does not have an advance care directive. Who is his substitute decision-maker?
His partner
