Capacity Assessment

Abstract

Capacity is the ability to make decisions. Autonomy in decision-making and being safeguarded against abuse and undue influence are fundamental human rights. This chapter will demonstrate how "good" capacity assessment can support these human rights. The assessment of capacity is a complex and highly specialized task, governed by principles of the presumption of capacity, that capacity is not diagnosis bound, and the need for individualized, task-, and situation-specific assessments. The clinician engaged to undertake a capacity assessment has a responsibility to act as gatekeeper, and sometimes advocate, for the actualization of human rights. Capacity assessment presents opportunities to identify strengths and weaknesses to inform and enable supported decisionmaking. It also provides opportunities and obligations to identify abuse. When people with disability such as mental illness are empowered to make the decisions they are capable of making, while protected from making the decisions they are incapable of making, human rights are supported. Such principles are universal, regardless of the jurisdictional variations in the laws that govern capacity and competency determinations internationally.

Beyond burnout II: A case series of doctors seen in a new publicly funded doctors’ mental health service

“…constituting notifiable conduct). 9 Other risks elucidated by the case of Lalita are the legal and professional risks associated with physical aggression, including potential for criminal charges and impact on professional practice, reputation and registration.…”

Beyond burnout I: Doctors health services and unmet need

“…A lthough the field of doctors' health had its origins in the 1990s, 1 the wellbeing of the medical profession has only been considered a priority in the last few years 2,3 brought to the fore by the COVID-19 pandemic. 4 We have long-recognised psychological morbidities of doctors, typified at the severe end by 'three Ds' (depression, drugs and drink) 5 often identified in doctors working in rural settings in psychiatry, anaesthetics and emergency medicine.…”

“…Although the field of doctors’ health had its origins in the 1990s, 1 the wellbeing of the medical profession has only been considered a priority in the last few years 2,3 brought to the fore by the COVID-19 pandemic. 4…”

Doctors’ health: Is there reason to hope?

“…It was not until the early 20 th century that it was even acknowledged that doctors could become mentally ill causing grounds for de-registration, although this was seen through a narrow focus on substance abuse. 1 In the 1970s, this was broadened to include physical and mental illness, with the American Medical Association defining practitioner impairment as: "the inability to practice medicine with reasonable skill and safety … by reason of physical or mental illness, including deterioration through the aging process, the loss of motor skills, or the excessive use or abuse of drugs, including alcohol". 2 It was not until the mid-1980s when a spotlight was shone on the plight of doctors (notably with a far more compassionate lens), 3 that the field of doctors' health came to fruition.…”

“…Some 35 years later, we now have data about everything from psychological symptoms such as depression and anxiety, to substance abuse and cognitive impairment. 1,4 We are not short of data pertaining to mental health of doctors, nor are we short of data documenting symptoms of dysfunctional medical cultures such as bullying and harassment, excessive workload, unpaid overtime, albeit focused on junior doctors. 5 What we are short of, is hope.…”