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Clinical Determination of Mental Competence: A Theory and a Retrospective Study

Clinical Determination of Mental Competence: A Theory and a Retrospective Study Abstract • In an attempt to establish a method for determination of mental competence, a two-part investigation was undertaken. First, a model for mental competence was devised that would be applicable across a broad range of neurologic disorders; this model was based on a patient's ability to make complex decisions. Second, a retrospective analysis of competence in 92 inpatients on a neurobehavioral service was carried out. The model was useful way to view competence, at least in this population. Competence could be classified as operational, limited to a single cognitive domain, or as general, cutting across all domains in a way for which no compensation could be devised. The results suggest that a model of competence based on analysis of individual congnitive operations will provide a sound clinical approach to a common problem that is presently not well characterized. References 1. Beresford HR: Severe neurological impairment: Legal aspects of decisions to reduce care . Ann Neurol 1984;15:409-415.Crossref 2. Relman A: The Quinlan decision: Judges as physicians . N Engl J Med 1978;298:499-500.Crossref 3. Beresford HR: The Quinlan decision: Problems and legislative alternatives . Ann Neurol 1977;2:79-81.Crossref 4. Lo B, Dornbrand L: Guiding the hand that feeds: Caring for the demented elderly . N Engl J Med 1984;311:402-404.Crossref 5. Duff RS, Campbell AGM: Moral and ethical dilemmas in the special care nursery . N Engl J Med 1973;289:890-894.Crossref 6. Alexander MP, Freedman M: Amnesia after anterior communicating artery aneurysm rupture . Neurology 1984;34:752-757.Crossref 7. Kirshner HS, Webb WG, Duncan GW: Word deafness in Wernicke's aphasia . J Neurol Neurosurg Psychiatry 1981;44:197-201.Crossref 8. Drane JF: Competency to give an informed consent: A model for making clinical assessments . JAMA 1984;252:925-927.Crossref 9. Warren JW, Sobal J, Tenney JH, et al: Informed consent by proxy: An issue in research with elderly patients . N Engl J Med 1986;315:1124-1128.Crossref 10. Stanley B, Guido J, Stanley M, et al: The elderly patient and informed consent: Empirical findings . JAMA 1984;252:1302-1306.Crossref 11. Annas GJ, Glantz LH: Rules for research in nursing homes . N Engl J Med 1986;315:1157-1158.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Clinical Determination of Mental Competence: A Theory and a Retrospective Study

Alexander, Michael P.
Archives of Neurology , Volume 45 (1) – Jan 1, 1988
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References (12)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1988.00520250029013
Publisher site
See Article on Publisher Site

Abstract

Abstract • In an attempt to establish a method for determination of mental competence, a two-part investigation was undertaken. First, a model for mental competence was devised that would be applicable across a broad range of neurologic disorders; this model was based on a patient's ability to make complex decisions. Second, a retrospective analysis of competence in 92 inpatients on a neurobehavioral service was carried out. The model was useful way to view competence, at least in this population. Competence could be classified as operational, limited to a single cognitive domain, or as general, cutting across all domains in a way for which no compensation could be devised. The results suggest that a model of competence based on analysis of individual congnitive operations will provide a sound clinical approach to a common problem that is presently not well characterized. References 1. Beresford HR: Severe neurological impairment: Legal aspects of decisions to reduce care . Ann Neurol 1984;15:409-415.Crossref 2. Relman A: The Quinlan decision: Judges as physicians . N Engl J Med 1978;298:499-500.Crossref 3. Beresford HR: The Quinlan decision: Problems and legislative alternatives . Ann Neurol 1977;2:79-81.Crossref 4. Lo B, Dornbrand L: Guiding the hand that feeds: Caring for the demented elderly . N Engl J Med 1984;311:402-404.Crossref 5. Duff RS, Campbell AGM: Moral and ethical dilemmas in the special care nursery . N Engl J Med 1973;289:890-894.Crossref 6. Alexander MP, Freedman M: Amnesia after anterior communicating artery aneurysm rupture . Neurology 1984;34:752-757.Crossref 7. Kirshner HS, Webb WG, Duncan GW: Word deafness in Wernicke's aphasia . J Neurol Neurosurg Psychiatry 1981;44:197-201.Crossref 8. Drane JF: Competency to give an informed consent: A model for making clinical assessments . JAMA 1984;252:925-927.Crossref 9. Warren JW, Sobal J, Tenney JH, et al: Informed consent by proxy: An issue in research with elderly patients . N Engl J Med 1986;315:1124-1128.Crossref 10. Stanley B, Guido J, Stanley M, et al: The elderly patient and informed consent: Empirical findings . JAMA 1984;252:1302-1306.Crossref 11. Annas GJ, Glantz LH: Rules for research in nursing homes . N Engl J Med 1986;315:1157-1158.Crossref

Journal

Archives of Neurology – American Medical Association

Published: Jan 1, 1988

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