Capacity Evaluations

Capacity is the ability to make reasoned, thoughtful decisions about, among other things, one’s person and assets. I am not an attorney but I frequently provide one piece of the process for determining if a person has diminished capacity to make personal decisions.

There is a presumption that everyone who is legally an adult has the capacity to make such decisions. In fact, they are held responsible for the outcome of this process. With aging and its vicissitudes, this cannot always be taken as a certainty. Neurological changes caused by disease like Alzheimer’s, Parkinson’s, multiple sclerosis or stroke (among others) can alter our capacity to make complex decisions that will have significant long term impact.

So, for example, an older person may lack capacity to fully appreciate that it is unsafe for them to drive or live on their own without assistance. There is no question that this means loss of independence but it also means that a loved one is at increasing risk for bad outcomes. It is frequently difficult for that person to see the latter and relatives are left with a difficult decision. Should they step in or risk their loved one or an innocent person being harmed?

Most of the time, the lack of capacity is obvious enough that it can be picked up on a physician. The doctor can complete the paperwork necessary for an attorney to file in court so a judge can make a determination about what is in the loved one’s best interest. However, in Maryland, where I practice, two certifications are required. The second one can be another physician but a licensed psychologist who has evaluated the person, can replace one of the medical doctors.

If a psychologist is part of this process, she should have training and experience with cognitive evaluation.