Patients' competence to complete advance directives can be easily assessed

Advance directives ("living wills") for medical care have been widely advocated as a means of extending the autonomy of patients when they are incompetent. Dementia is one clinical situation for which advance directives could potentially be useful. However, there are few tools that can assess the competence to complete advance directives. On p 493 Fazel et al describe a semistructured interview to assess such competence, which uses clinical vignettes and a questionnaire comprising 10 points and takes about 15 minutes to complete. This approach involves testing the ability of people to imagine possible future clinical situations. The authors argue that doctors should take the approach of enabling patients with mild cognitive impairment to complete advance directives.


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Relevant Article

Assessment of competence to complete advance directives: validation of a patient centred approach

Seena Fazel, Tony Hope, and Robin Jacoby
BMJ 1999 318: 493-497. [Abstract] [Full Text] [PDF]