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Decision-Making Capacity - under the medical model

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You must also tell the patient that he/she should memorize those words and that ... Attention: Can you spell the word WORLD forwards, then backwards? ... – PowerPoint PPT presentation

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Title: Decision-Making Capacity - under the medical model


1
Decision-Making Capacity- under the medical model
  • Dr. Michael A. Valente

2
  • Competency judicial determination ruling on a
    persons global decision-making ability
  • Capacity clinical observations of a persons
    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

3
  • Consent to Treatment
  • Medical Model problem specific
  • Does presence of physical disease impair
    judgment?
  • Does presence of emotional disorder psychiatric
    disease impair judgment?

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  • 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 patients judgment and
    insight

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? 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.) 3
Language 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? 3
Reading Read and obey, CLOSE YOUR EYES. 1
Writing Can you write a sentence? 1
Visuospatial Have patient copy intersecting pentagons 1
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 12189, 1975.
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  • 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
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