moberg_competency - Applied Neuropsychology 2006, Vol. 13,...

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Evaluation of Competency: Ethical Considerations for Neuropsychologists COMPETENCY EVALUATIONS Paul J. Moberg Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA and Parkinson’s Disease Research, Education, and Clinical Center (PADRECC), Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania, USA and Alzheimer’s Disease Center (ADC), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA Kathryn Kniele Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA The assessment of decision-making capacity is an essential element of competency determina- tions. As experts in the assessment of human cognitive abilities, neuropsychologists may be the best adjudicators of competency. However, to maximize the contribution of neuropsychology to the courts in the determination of competency, clinicians must be aware of the professional controversies and ethical challenges inherent in the assessment of decision-making capacity and the determination of competence. Professional controversies include the lack of estab- lished methodological and procedural guidelines for capacity evaluations and the application of variable criteria to establish impairment. Ethical challenges include balancing the need to respect the individual’s freedom of choice and self-determination with the need to promote the individual’s safety; attaining professional competence; and selecting, using, and interpreting assessment methods appropriately. The purpose of this article is to examine these issues in the context of neuropsychological practice. Key words: competency, cognitive capacity, neuropsychology, ethical considerations As experts in the assessment of human cognitive abilities, neuropsychologists may be the best adjudica- tors of competency given that issues of competency al- most inevitably boil down to determination of deci- sion-making capacity. However, “competency” is a legal construct established and governed by the courts that is substantively different than decision-making capacity, although the terms are often used interchange- ably. In the broadest sense, competency refers to an in- dividual’s capacity to decide or to perform activities of are the capacities to work, drive, parent, make medical decisions, provide informed consent in treatment and research settings, care for oneself or one’s property, and enter into legal contracts (e.g., designate a will). Com- petency rulings are also relevant in civil and criminal litigation, wherein a person’s understanding of the is- sues relevant to participation in a particular legal pro- ceeding is of primary concern. In criminal contexts, recognized legal capacities include the capacity to stand trial, waive Miranda rights, and bear the burden of criminal responsibility. Applied Neuropsychology
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This note was uploaded on 12/01/2011 for the course CLP 7934 taught by Professor Staff during the Summer '08 term at University of Florida.

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moberg_competency - Applied Neuropsychology 2006, Vol. 13,...

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