This report demonstrates the discrepancy that can occur between clinical and test evaluations of competence. It presents retrospective examination of 35 assessments of competence performed on 24 subjects by a multidisciplinary competency panel. The findings of the panel are compared with the subjects' results on the Cognitive Competency Test and on the Mini-Mental State Examination. The results show that the multidisciplinary competency panel will more often find subjects competent than indicated by their psychometric test scores. A process approach to the use of tests is recommended. Reliance on tests to decide the outcome of difficult cases does not appear to be warranted.
References
1.
HommelP, WangL, BergmanJ.Trends in guardianship reform: implications for the medical and legal professions. Law, Medicine and Healthcare1990; 18(3): 213–226.
2.
PetersR, SchmidtW, MillerK.Guardianship of the elderly in Tallahassee, Florida. Gerontologist1985; 25: 532–538.
3.
ChristieJ.Guardianship: the Alberta experience, a model for change. Health Law in Canada3(3): 58–66.
4.
SilberfeldM.Competency assessments. Journal of Estates and Trusts1991; 11(2): 165–175.
5.
SilberfeldM.New directions for competency assessments. The Family Physician (in press).
6.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behaviourial Research. Making Health Care Decisions.Washington DC: US Government Printing Office, 1982.
7.
WeisstubD.Enquiry on mental competency, final report. Toronto ON: Queen's Printer of Ontario, 1990.
8.
SilberfeldM.The value of clinical judgment in competency assessments. Health Law in Canada1991; 11(3): 68–69,83.
9.
LoB.Assessing decision-making capacity. Law, Medicine and Healthcare1990; 18(3): 193–201.
10.
WangP, EnnisK, CoplandS.CCT manual. Toronto ON: Department of Psychology, Mount Sinai Hospital, 1987.
11.
WangPL, EnnisKE. Competency assessment in clinical populations: an introduction to the Cognitive Competency Test. In: UzzelBP, GrossY, eds. Clinical neuropsychology of intervention. Martinus Nijoff Publishing, 1986.
12.
FolsteinMF, FolsteinSE, McHughPR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res1975; 12: 189–198.
13.
AnthonyJC, LeRescheL, NiazU, Limits of the “Mini-Mental State” as a screening test for dementia and delirium among hospital patients. Psychol Med1982; 12: 397–408.
14.
MolloyWD, AlemayehuE, RobertsR.Reliability of a standardized Mini-Mental State Examination compared with the traditional Mini-Mental State Examination. Am J Psychiatry1991; 148(1): 102–105.
15.
SilberfeldM, HarveyWRC, DickensBM, A competency clinic for the elderly at Baycrest Centre for Geriatric Care. Advocate's Quarterly1988; 10: 23–28.
16.
WinbgradCH. Mental status tests and the capacity for self care. JAMA1984; 32: 49–55.
17.
FittenLT, LuskyR, HammanC.Assessing treatment decision-making capacity in elderly nursing home residents. J Am Ger Soc1990; 38: 1097–1104.
18.
KaplanE.The process approach to neuropsychological assessment of psychiatric patients. Journal of Neuropsychiatry1990; 2: 1–11.
