Lesson 24: Capacity


Attention


Learning Outcomes

Upon completion of this lesson's material, students will be able to:

  • Identify the processes associated with assessment for capacity
  • Identify the legal and ethical differences between POA and Guardianship

Teaching

Read Chapter 16 in Cohen & Eisdorfer

"The concepts of capacity and competency embody complex value systems about liberty, personal choice, autonomy, and aging as well as clinical, ethical, and legal concerns." (p. 183)

Assumptions about Age and Competence

  • Legal statutes exist related to persons under 18
  • No legal statutes exist related to older persons vs. younger persons
  • Ageism is a destructive influence
  • Beliefs that advancing age inevitably leads to a general decline in the abilities to function independently
  • Personal expectations by older people to participate in their own decisions

Measuring Mental Capacity

  • Physical and mental state
  • Medication effects
  • Individual's attitude
  • Setting of the examination
  • Attitude and approach of the examiner

Issues related to Capacity

  • Capacity to Consent to Treatment
  • Capacity to Consent to Research
  • Testamentary Capacity
  • Conservatorship and Guardianship
  • Alternatives to Guardianship
    • Mediation
    • Advanced Planning / Advanced Directives (Patient Self Determination Act)
  • Health Care Decision Making

There is a great story related to Mollie Orshansky in your textbook...click HERE to view the entire Senate Special Committee on Aging hearing

Click HERE to visit the State of Maine Guide to Guardianship (and alternatives to guardianship)

Review the material HERE to introduce yourself to the processes involved in determining guardianship.

Click HERE to view the forms used for Advanced Directives


Assessment

Lesson 24 Discussion

The role of POAs (Power of Attorney) is often overstated in long-term care settings. Individuals with a Health Care POA can access medical records of the client and can participate in decision making, but it is not guardianship. Discuss how we might work with an individual who is "demanding" but is only a POA. Consider also that we want the family member (the POA) to be involved...many just not so much! You may relate personal experience in these types of situations to this discussion and I will be adding some stories to the discussion as well.

Lesson 24 Quiz

  1. Summarize (briefly) the "six pillars" involved in the assessment of capacity.
  2. Research on the web for resources as to the differences between a POA, a Durable POA, and a Guardian. In your answer make it clear when you are talking about each and include a reference (or references) to where you got the information.