Competency
Who Should Evaluate Competency?
Although competency is at root a legal determination, physicians routinely make competency judgments in the acute care setting. While these determinations could theoretically be challenged in court retrospectively, they rarely are. For non-urgent competency evaluations, such as competency of a person for nursing home placement, a court hearing must be held and a formal guardian appointed. Physicians' opinions are rarely challenged in these more formal legal settings. What type of physician should make competency evaluations? The answer is relative to the situation. Psychiatrists and clinical psychologists are the most trained to recognize and treat mental illness. Many of these specialists are experienced in competency evaluations. However, if a patient is comatose, severely demented, or wildly psychotic, and the situation is urgent, an expert opinion may be superfluous; the competency determination may be readily handled by the primary physician.
STUART YOUNGER, M.D.
BIBLIOGRAPHY
APPELBAUM, P. S., and GRISSO, T. "Assessing Patients' Capacities to Consent to Treatment." New England Journal of Medicine 319 (1988): 1635–1638.
APPELBAUM, P. S., and ROTH, L. H. "Clinical Issues in the Assessment of Competency." American Journal of Psychiatry 138 (1981): 1462–1467.
BUCHANAN, A. E., and BROCK, D., W. Deciding for Others: The Ethics of Surrogate Decision Making. Cambridge, U.K.: Cambridge University Press, 1989.
CULVER, C. M., and GERT, B. "The Inadequacy of Incompetence." The Millbank Quarterly 68 (1990): 619–643.
DRANE, J. F. L. "The Many Faces of Competency." The Hastings Center Report 15 (1985): 17–21.
MEISEL, A.; ROTH, L. H.; and LIDZ, C. W. "Toward a Model of the Legal Doctrine of Informed Consent." American Journal of Psychiatry 134 (1977): 285–289.
ROTH, L. H.; MEISEL, A.; and LIDZ, C. W. "Tests of Competency to Consent to Treatment." American Journal of Psychiatry 134 (1977): 279–284.
YOUNGNER, S. J. "Competence to Refuse Life-Sustaining Treatment." In End of Life Decisions: A Psychosocial Perspective. Edited by M. D. Steinberg and S. J. Youngner. Washington D.C.: American Psychiatric Press, 1998. Pages 19–54.
Additional topics
Medicine EncyclopediaAging Healthy - Part 1Competency - Competency And Capacity, Drawing The Line Between Competency And Incompetence, Who Should Evaluate Competency?