Decision-Making Capacity - under the medical model Dr. Michael A. Valente

Competency: judicial determination ruling on a person’s global decision-making ability Capacity: clinical observations of a person’s ability to negotiate tasks and procedures Task or intervention specific Expression of values and preferences in isolation from being able to carry out other higher executive functions Does not require legal or psychiatric evaluation

Medical Model: problem specific Consent to Treatment Medical Model: problem specific Does presence of physical disease impair judgment? Does presence of emotional disorder – psychiatric disease impair judgment?

Medical Model Mini Mental Status Exam Quantitative measure of cognitive function Examination of thought processes based heavily on language function and visual-spatial relatedness Clinical assessment of patient’s judgment and insight

 Mini Mental Status Exam Parameter Score Orientation: What is the month, day, date, year, season? Where are you, what floor, city, county, state? (Score 1 point for each item correct.) 10 Registration: State three items (ball, flag, tree). (Score 1 point for each item that the patient registers without you having to repeat the words. You may repeat the words until the patient is able to register the words but do not give them credit. You must also tell the patient that he/she should memorize those words and that you will ask him/her to recall those words later.) 3 Attention: Can you spell the word WORLD forwards, then backwards? Can you subtract 7 from 100, and keep subtracting 7? 5 Memory: Can you remember those three words I asked you to memorize? (Do not give clues or multiple choice.) Language: Naming: Can you name (show) a pen and a watch? 2 Repetition: Can you repeat “No if's, and's, or but's”? 1 Comprehension: Can you take this piece of paper in your right hand, fold it in half, then put it on the floor? Reading: Read and obey, “CLOSE YOUR EYES.” Writing: Can you write a sentence? Visuospatial: Have patient copy intersecting pentagons TOTAL 30 Adapted from Folstein MF et al: “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189, 1975.

Clinical assessment of Judgment and Insight The ability to communicate is present The ability to understand the proposed treatment and alternative interventions The ability to grasp the consequences of accepting and of declining the suggested treatment The ability to reason If present, does mental illness impair judgment