Assessing mental capacity: How much and what kind of standardization is appropriate?

Helena Hermann presented on the XVI World Congress of Psychiatry in Madridon the appropriate way of standardizing mental capacity assessments.

In view of the ethical implications entailed in competence judgments, a valid evaluation of patients‘ mental capacity is essential. For this reason, structured interviews have been developed to support an objective and reliable assessment.

Despite the laudable intent of such instruments, it seems just as important to consider the dawnside of standardized procedures, particularly when complex issues such as mental capacity are at stake. Therefore, the presentation aimed at pointing out potential drawbacks of standardization in capacity evaluations.

By doing so, two particular aspects have been highlighted that seem to require less or different sorts of standardization:

a) mental capacity is about patients‘ decision-making which is highly idosyncratic, dependent on individuals‘ decision-making styles and preferences; and

b) mental capacity is not a purely objective commodity but strongly underpinned with normative reflections which make a check-box-approach inappropriate as well.

On these grounds, an alternative approach was proposed which does not primarily try to standardize the assessment of relevant mental abilities but the physicians‘ process of coming to a judgment.