Decision Making Capacity
Decision Making Capacity
It is often asked: Does this person have the capacity to make decisions?... from which the answer is almost always... Well , it depends.
This exchanged highlights there is no simple answer to a complex problem and that decision making capacity is highly specific. For instance, a person may have the capacity to make decisions about what to eat, where to live and what activities they wish to participate in. This capacity for decision making may be very different compared to that of making decisions surrounding managing money, real estate or medical decisions. As such, it is important to think of decision making capacity in relation to specific domains or areas.
In Victoria, Australia, the Victorian Civil and Administrative Tribunal (VCAT) make orders as to whether one is considered to be competent to make decisions or not. They often rely upon neuropsychological assessment reports that have directly addressed the questions and areas for which decision making is being considered. VCAT has the power to make orders across a number of areas including:
- appointing guardians to make decisions for a person, including the person's accommodation;
- appointing administrators to manage a person's financial and legal affairs;
- revoking an attorney's appointment, or varying, suspending or making another order in relation to a financial EPA (enduring power of attorney) under the Instruments Act 1958;
- revoking or suspending an enduring power of attorney (medical treatment) under the Medical Treatment Act 1988;
- consenting to a "special procedure", that is:
- a procedure intended or likely to cause infertility;
- termination of pregnancy;
- removal of tissue for transplanting.
VCAT can also make highly specific findings, such as that a guardian is need to make a specific decision about a certain medical treatment only. This can occur at times as VCAT is required to make the least restrictive orders.
It is also important to understand that one's capacity for decision making may vary over time and thus it may be important to have review assessments to determine if capacity in a specific area has changed. An example of this is when a person is in the early stages of recovery from a severe brain injury. They may not be initially competent to make financial decisions, but over time, as their recovery occurs, they can often regain competency.
So, what is decision making capacity?
Decision making capacity is having the ability to understand and appreciate (relevant) information. The person is required to receive pertinent information as well as known risks, options, and consequences of their decisions. Their choices also depend on their personal values and goals.
Making a bad decision is not evidence of not having decision making capacity.
Cognitive reserve and brain reserve may impact on a person's recovery following a severe brain injury and cognitive, behavioural and emotional function and dysfunction can all impact upon a person's capacity to make decisions. Neuropsychological testing can delineate these areas of function and make findings as to whether decision-making capacity is functional or not.
Remember at the time of referral it is important to ask... Does this person have the capacity to make decisions about: (what, something specific)?
Neurodynamics provides tailored a neuropsychological assessment service that can assist with determining competency. Please contact us if you require assistance in this area.
End
