Capacity

Within the context of intellectual and cognitive functioning, a person is incapable of managing his or her own affairs if two criteria are met. First, they must have an objective deficit likely to impair problem-solving and decision-making. Second, they must be incapable of sensibly delegating responsibility to someone else. Cognitive assessment obviously bears upon both of these issues. In the first instance assessment can help gauge whether there is a deficit at all, and if so the severity of that deficit and its precise nature. For example, most people would be able to manage their own lives despite some mild reduction in intellectual efficiency or some mild memory problem—after all, this is in any case the course of natural ageing. But it is much more difficult to cope with a severe memory deficit, for example, when it may be difficult for the person to bring the relevant information to mind so as to reach a competent decision, or to hold it long enough in mind to make that decision. In the second instance, cognitive assessment can point to deficits which make it unlikely that the person can appropriately delegate certain responsibilities. For example, those with dysexecutive syndrome may be gullible or impulsive over whom to approach for advice, or may be reluctant to accept advice, may delegate only inconsistently, or may say they accept certain advice but then do the opposite. In short, they cannot plan to delegate or, if they do make such plans, the plans are poorly monitored and inconsistently implemented. All this is a question of judgement rather than pure test results. There is no psychometric test of capacity as such, but there is a growing trend for tests to reflect real life functioning, which make it easier to draw out the implications of test results for daily living. For example, Goel et al.(49> directly observed financial decision-making in analogues of planning tasks.

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