Guiding Principles and Common Pitfalls of Capacity Assessment

Guiding Principles and Common Pitfalls of Capacity Assessment
Book Chapter
Dede Ukueberuwa O’Shea, Nicolette Gabel, Sarah Aghjayan, Maximilian Shmidheiser, Ross Divers
A Casebook of Mental Capacity in US Legislation, 2022 [Routledge]
Abstract
Psychologists must consider many complexities of professional practice and individual rights when conducting capacity assessments. This chapter reviews principles and standards that guide psychologists in conducting these evaluations. This chapter provides an overview of foundational abilities of an individual’s decisional capacity according to contemporary models, followed by a discussion of the widely accepted assumptions of decisional capacity assessment: inclusivity, decision-relativity, all-or-nothing assessment, value neutrality, and independence from diagnosis. In conducting capacity assessments, psychologists will also benefit from an understanding of the key bioethics principles of autonomy, beneficence, nonmaleficence, justice, informed consent, and voluntarism. This chapter then reviews specific standards of ethical practice relevant to capacity determinations that are outlined by the American Psychological Association (APA) and medical organizations. This chapter provides details on informed consent procedures in the context of evaluating decisional capacity, as well as standards that describe the need to practice within boundaries of competence, handle third party request for services, cooperate with other professionals, maintain confidentiality and make ethical disclosures, and limit conflicts of interest. Finally, this chapter discusses common pitfalls that psychologists may face when conducting capacity assessments and outline recommendations for best practices in gathering information and working with patients of diverse histories.