निर्णय लेने की क्षमता का मूल्यांकन क्या है?

A decision-making capacity assessment looks at whether a person can make a particular decision for themselves, at a particular time. It might be about a will, money, medical treatment or where to live.

Families often ask for a capacity assessment when a loved one has dementia, a stroke or a brain injury, or when a lawyer needs clear evidence. This guide explains what capacity means, who can assess it, what happens on the day and what the results can and cannot tell you.

What decision-making capacity means

Decision-making capacity is a legal idea. It asks whether a person can make a specific decision, not whether they are clever or well.

In Victoria, the Guardianship and Administration Act 2019 says a person has capacity for a decision if they can:

• understand the information relevant to the decision and its effect
• retain that information long enough to make the decision
• use or weigh the information as part of making the decision
• communicate the decision in some way, such as by speech, gestures or other means.

The Victorian Department of Health explains that all adults are presumed to have capacity unless shown otherwise. Other states use similar ideas, although the exact legal tests differ.

Four principles worth knowing

• Capacity is presumed. Nobody has to prove they have it.
• It is decision-specific. Someone may be able to decide what to eat or who to see, but not how to sell a house.
• It can change over time. Illness, pain, medication or delirium can affect capacity for a while.
• An unwise choice is not the same as incapacity. The NSW Capacity Toolkit says to assess the person’s decision-making ability, not the decision they make.

A person also has capacity if they can make the decision with practicable and appropriate support. Support might mean plain-language information, an interpreter, hearing aids or extra time.

When a capacity assessment might be needed

Most everyday decisions never need a formal assessment. One may help when a decision is significant, when there are concerns, or when a lawyer, tribunal or health service needs evidence. Common examples include:

• making or changing a will
• making or cancelling an enduring power of attorney
• selling property, making a large gift or signing a contract
• moving into residential aged care
• consenting to or refusing medical treatment
• an application to VCAT, NCAT or another tribunal for a guardian or administrator
• a legal dispute about decisions made in the past.

Concerns often arise after a diagnosis of dementia, a stroke, an acquired brain injury, a serious mental illness, or where a person has an intellectual disability. A diagnosis alone does not answer the question. Many people with these conditions can still make many of their own decisions.

Who can assess capacity

Different professionals assess capacity depending on the decision and how complex it is. A GP may be able to give an opinion for simpler matters. A lawyer also forms a view about capacity when taking instructions for a will or power of attorney.

The Victorian Department of Health suggests that formal assessments are done by clinicians experienced in assessing cognition, such as neuropsychologists and geriatricians. The NSW Capacity Toolkit suggests seeking a specialist when there is a dispute, family disagreement or a serious decision.

A neuropsychologist (a psychologist with specialist training in how the brain affects thinking and behaviour) can measure which thinking skills are affected and which are still strong. This helps explain why a person may manage one decision but struggle with another.

Researchers Purser and Rosenfeld have argued that doctors and lawyers should work together, and that the referral should clearly state the legal question. A clinician gives an opinion. The final legal decision may rest with a court or tribunal.

What happens during an assessment

Before the appointment

The clinician needs to know exactly which decision is in question. A lawyer or family member usually provides background, such as medical history, the relevant documents and a summary of the person’s assets or care options. The person being assessed is told the purpose of the assessment and asked for consent.

On the day

A neuropsychological capacity assessment usually includes:

• a conversation about the person’s life, values and what they want
• questions about the specific decision, such as what a will does or what an attorney can do
• standardised tests of memory, attention, language, reasoning and planning
• with consent, information from family members, carers or treating doctors.

The clinician looks for the conditions that help the person do well. This can include a quiet room, a support person, an interpreter, glasses and hearing aids, and a time of day when the person is usually at their sharpest.

After the appointment

The clinician writes a report. It should state the decision assessed, what the person understood, how they reasoned, the clinician’s opinion and the reasons for it. It may also suggest supports or say when a review would be sensible.

Before the assessment, it should be agreed who will receive the report. Health information is private, so the clinician will explain who can see the report and how it may be used, for example by a lawyer or tribunal.

What the result means, and what it does not

A finding that a person lacks capacity for one decision does not mean they lack capacity for everything. It is also a snapshot. If the cause is temporary, such as delirium, the person may regain capacity.

Victorian law also recognises supported decision-making. For example, a person can appoint a supportive attorney to help them gather information and communicate their own decisions, without deciding for them.

Where a person cannot make a decision even with support, there are usually other options. They may have already appointed an attorney or decision maker. If not, a tribunal such as VCAT can appoint someone. Tribunals are asked to choose the least restrictive option and to consider what matters to the person.

How to prepare

• Be clear about the decision in question and why it matters now.
• Gather relevant documents, such as a draft will, previous wills or care plans.
• Bring a list of medications, glasses, hearing aids and any communication aids.
• Tell the clinic about language, cultural or accessibility needs in advance.
• Explain the appointment to the person in a calm, honest way.
• Plan for rest breaks and a snack, as long appointments can be tiring.

Invictus Health कैसे मदद कर सकता है

Our psychologists and neuropsychologists provide निर्णय लेने की क्षमता का मूल्यांकन for individuals, families, lawyers and services. We also offer broader neuropsychology assessments और medico-legal assessments. Neuropsychology reports are reviewed by Dr Judy Tang OAM.

We have assessment clinics in every state and territory. You can find a clinic near you, and no GP referral is needed to book most assessments. This article is general information and is not legal advice. Please speak with a qualified professional about your own situation.