Assessment of competence to complete advance directives

doi:10.1136/bmj.318.7200.1765

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Standardised instruments are needed to guide the measurement of competence

Saskia Teunise, Senior psychologist, psychology department, community mental health unit (Steunisse@boreas.clara.net),
Sarah Eagger, Senior lecturer in old age psychiatry,
James Warner, Senior lecturer in old age psychiatry

St Charles Hospital, Exmoor Street, London W10 6DZ
Section of Old Age Psychiatry, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX

EDITOR—Fazel et al described an instrument for the assessment of competency to complete advance directives that seems to be reliable, valid, and ready for use in clinical practice.1 We believe, however, that certain aspects require clarification before the clinical usefulness of the test is assured.

Firstly, who is this test meant for? Different groups are suggested in different parts of the text. Is it meant to differentiate between competency and incompetency in demented patients, in the broader group of patient with cognitive impairment, or in elderly volunteers? If the test aims to assess competency in dementia, test-retest analysis should include only data on demented patients, because fluctuations in …