Transcript Competency Assessment - MANAIA HEALTH PHO LIMITED

Competency Assessment
Competency and Capacity
Capacity/Competency
– Legal, clinical, ethical and social construct
– “Ability of an individual to make autonomous
choices”
– Task specific
– May vary over time
– Not diagnosis dependent
– Culturally mediated
Why Assess Competency
Expertise
– Some older people, particularly those with cognitive
impairment are likely to lose capacity to perform tasks
and make decision
– Medico-legal expert in evaluation of cognitive
disorders and associated risks
Duty of care
– Those who lose capacity may become vulnerable to
abuse or neglect
– Those who lose capacity may place themselves or
others at risk
When are we asked to assess
competency?
Impaired ability to communicate
Disorder of brain or mind which it is
suspected will impair decision making
abilities (not just dementia: depression
psychosis mania intellectual disability)
Person judged to be making unwise
decisions
Person is at risk of harm
Undue influence/Abuse
Definitions of Capacity
Appelbaum and Grisso
– 1)ability to express choice
– 2)ability to understand relevant information
– 3)ability to appreciate the significance of
information for one’s own situation
– 4)ability to reason with relevant information so
as to engage in a logical process of weighing
options
–
Appelbaum TS, Grisso P. N Engl J Med 1988: 319; 1635-38
A capable person (5 Cs)
knows the context of the decision at hand
knows the choices available
appreciates the consequences of specific
choices
is consistent in their decisions
can communicate their decisions
Autonomy
“self” and “law”
"one who gives oneself their own law")
it refers to the capacity of
a rational individual to make an informed,
un-coerced decision.
Self-determination.
Autonomy
Presumption of competence.
A person is assumed competent until
proven otherwise.
The autonomy of a competent person
must be respected
This is often at odds with the principle of
Benificence or “doing good”
Preservation of Autonomy
PPPR Act Section 8
(a) To make the least restrictive
intervention possible in the life of the
person in respect of whom the application
is made, having regard to the degree of
that person's incapacity:
(b) To enable or encourage that person to
exercise and develop such capacity as he
or she has to the greatest extent possible.
Sliding Scale of Capacity
Assessment (Shulman 2007)
PPPR Act
Duties and responsibilities of welfare guardians /
property managers /attorneys
– To act in the subject persons best interests
– Allow subject person to exercise capacity to the
greatest extent capable
– To act in good faith and with due care
– Liability
– Reporting requirements
– Integrate into the community as much as possible
– Consult with the person
PPPR Act
Enduring Power of Attorney
– Property
– Welfare
Welfare Guardianship Orders (S12)
Property Management
Personal Orders S10)
Types of order
Section 10 (1) a-k personal orders of
specific types (including)
– d) enter,attend or leave an institution (other
than a psychiatric hospital
– e)be provided with living arrangements
specified
– f) be provided with medical advice or
treatment
Types of order cont
Section 10 cont
– g)educational, rehabilitative or therapeutic or
other services
– h) that a person shall not leave the country
– j) that a person named in section 11 may
administer an item of property
Welfare Guardianship
Section 12
(2) A Court shall not make an order under subsection (1)
of this section unless it is satisfied—
(a) That the person in respect of whom the application is
made wholly lacks the capacity to make or to
communicate decisions relating to any particular aspect
or particular aspects of the personal care and welfare of
that person; and
(b) That the appointment of a welfare guardian is the
only satisfactory way to ensure that appropriate
decisions are made relating to that particular aspect or
those particular aspects of the personal care and welfare
of that person.
Powers of Attorney
(a) In relation to property, if the donor is not wholly
competent to manage his or her own affairs in relation to
his or her property; or
(b) In relation to personal care and welfare, if the
donor—
(i) Lacks, wholly or partly, the capacity to understand the
nature, and to foresee the consequences, of decisions in
respect of matters relating to his or her personal care
and welfare; or
(ii) Has the capacity to understand the nature, and to
foresee the consequences, of decisions in respect of
matters relating to his or her personal care and welfare,
but wholly lacks the capacity to communicate decisions
in respect of such matters
Powers of Attorney
Legal instrument appointing person to make
decisions on the donor’s behalf
Must be made on prescribed form
Formal witnessing procedure including
requirement to assess donor’s capacity to
appoint attorney.
Must be signed by the attorney
May specifiy when activated ( property)
Specifies type of person to evaluate mental
capacity
Powers of Attorney
For welfare can be only one person but
may specify who can take over
For property can be more that one person
Requirements to act in the person’s best
interests
Requirements to encourage donor to
develop and exercise capacity
Powers of Attorney
Potentially 2 points at which decision
making capacity needs to be assessed
– When the document is drawn up, or the
Attorney appointed
– When the Attorney needs to start exercising
their powers – ie when the donor has become
partly or wholly incompetent with respect to
welfare or property
Specific Decisions:Appointing an
EPOA
A legal document which appoints someone to
make decisions for them
2 kinds of EPOA/ separate documents
How many attorneys
What kinds of decisions are covered
When it is activated ( when is it likely to be
activated); when it can be revoked.
Who has final say once activated
Who is the proposed attorney and reasons for
choosing that person vs others
Monitoring provisions