Assessing Competence in Psychiatric Contexts

Competence allows people the unencumbered legal right to choose how they will manage their personal affairs, or when to accept (or reject) health care. Those who are not capable of making informed choices for themselves, typically the elderly and those with intellectual and psychiatric conditions, generate a range of dilemmas in meeting the needs of people whose competence is called into question. Over the past two decades, medicine and law have attempted to devise practical and legal processes for the authorization of procedures or decisions when an individual is unable to provide consent. Despite this, there remains a lack of consensus on both the exact criteria and the method for assessing mental competency. What is clear, however, is the need for professionals, whether they are involved in developing the criteria and methods of assessment or in applying them, to look closely at each individual in the context of his or her everyday life. This paper examines the wider area of competence, how it is determined and applied from a medical and legal paradigm, and the implications that arise from this. It also discusses the various models of competence at a conceptual level and provides an overview of New Zealand's recent adult-guardianship laws.