When the Mind Fails

When the Mind Fails: A Guide to Dealing with Incompetency

Michel Silberfeld
Arthur Fish
Copyright Date: 1994
Pages: 184
https://www.jstor.org/stable/10.3138/9781442683341
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  • Book Info
    When the Mind Fails
    Book Description:

    Incompetency is loss of the ability to make, and act on, your own decisions and with the aging of North America's population, it is increasingly widespread. It can happen to anyone and many people want to plan for its possibility in order to ensure their own care and protection. Incompetency can cause great, but often avoidable, suffering and emotional anguish to those afflicted by it, as well as the relatives and friends who care for them. People in health care, financial services, and law must deal with clients whose competency in some, or all, matters can be questioned. Addressing the needs of incompetent people, or planning for its possibility, requires knowledge about what incompetency is, how to recognize and react to it, and what kinds of professional advice to seek. This book is a practical, focused guide to thinking about incompetency, as useful to the layman as to those who perform, or refer clients to, competency assessments.

    Addressing the needs of incompetent people, or planning for its possibility, requires knowledge about what incompetency is, how to recognize and react to it, and what kinds of professional advice to seek. This book is a practical, focused guide to thinking about incompetency, as useful to the layman as to those who perform, or refer clients to, competency assessments.

    Michel Silberfeld, a doctor, and Arthur Fish, a lawyer, draw on their experience at a competency clinic, citing fictional but realistic case studies and offering many concrete examples. The clinic is multidisciplinary and founded on the principle that competency is not simply a medical or legal concept, but rather a complex phenomenon that has medical, social, legal, and ethical dimensions. Silberfeld and Fish follow the same principle in the advice they offer.

    There are fundamental problems associated with incompetency and many similarities among the laws and social policies that apply to incompetent people in North America. This book is not a substitute for qualified professional help but it is a practical guide to thinking about incompetency, based on the premise that the best source of personal empowerment is knowledge and understanding.

    eISBN: 978-1-4426-8334-1
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Preface
    (pp. vii-2)
    Michel Silberfeld and Arthur Fish
  4. Introduction
    (pp. 3-7)

    Incompetency has become a major social problem in large part because the number of elderly people in North America is increasing rapidly. Although incompetency afflicts people of all ages and may arise from many causes it is a problem frequently seen among the elderly. It has become increasingly evident to us, and to others, that there is a great need for a book that outlines the fundamental principles and basic practices of competency assessment. Scientific inquiry into competency is not sufficiently advanced for anyone yet to be able to write the final word on competency assessment. Moreover, there are many...

  5. CHAPTER ONE What is incompetency ?
    (pp. 8-25)

    When talking about competency and incompetency we are dealing with matters that lie close to the core of our humanity. The word competent literally means ʻhaving sufficient abilityʼ to perform a specific task, and it is related to a number of other terms, like independence, self-esteem, and happiness, that are commonly used to describe the qualities of a life that is worth living. Competency is a personʼs ability to make, and act on, his or her own decisions. The ability to decide what to do, and then to do it, is closely connected with how people feel and think about...

  6. CHAPTER TWO Incompetency as a human problem
    (pp. 26-43)

    These nine cases illustrate a number of important points that are discussed elsewhere in this book. One extremely important point has already been raised but bears repetition - competency generally becomes an issue in emotionally and spiritually trying circumstances, while people are trying to cope with a host of serious problems that have arisen because they are mentally ill, aging, or have suffered a brain injury. Questions about competency tend to be raised by, and about, individuals who are already angry, confused, or upset by the turn that their life or the life of a relative or friend, has taken....

  7. CHAPTER THREE Assessing competency
    (pp. 44-52)

    Three truths constitute the foundation for thorough, fair, and accurate competency assessments.

    1 Incompetency (also called incapacity) means the absence of the capacity to make choices or decisions.

    2 Competency is not a single ability that people either have or lack. People use different abilities to make different kinds of choices, and so they may be competent to make some decisions but incompetent to make others. Competency is task-specific.

    3 Competency assessments must look at the whole individual. The fact that a person has a mental illness, a mental handicap, or a brain injury, or has performed poorly on standard...

  8. CHAPTER FOUR Informal competency assessment
    (pp. 53-74)

    Informal assessments determine whether there is good reason to think that another person may be incompetent. Such assessments can be, and are, performed by many different people in many different circumstances. Later in this chapter some detailed cases of informal assessment will be presented, but it may be helpful at the outset to offer examples of common situations in which informal competency assessments are often performed.

    Lawyers who prepared wills for elderly people often attempt to satisfy themselves that their clients know what a will is, want to make one, and are a capable of coming to decisions about the...

  9. CHAPTER FIVE Formal competency assessment
    (pp. 75-121)

    This chapter is about the formal assessment of competence. Unfortunately, there are as yet no widely accepted standards for formal competency assessment and practice varies widely. Different groups of health-care professionals have different ideas about what an assessment should involve, and even members of the same professional group may perform competency assessments differently. Readers should not be surprised to find that they, or their friends or relatives, receive a competency assessment that is quite different from those described in this chapter. This chapter serves two purposes: First, to describe the kind of psychological testing that is a common and valuable...

  10. CHAPTER SIX Guardianship and other imposed care
    (pp. 122-140)

    When people who have not planned for their own care while competent become chronically incompetent, it is sometimes necessary to have a judge appoint a guardian for them. In doing so, the judge will often rely on reports from a competency assessor. People who seek assessments that may lead to guardianship, and the assessors who perform them, should therefore be especially conscious of their duty to safeguard individual liberty. To understand why this is so, it is necessary to consider the nature of guardianship, and especially the loss of individual rights that it entails. As a general rule, one should...

  11. CHAPTER SEVEN Planning for incompetency
    (pp. 141-176)

    Too often competency assessment is considered solely in relation to the imposition of guardianship. This lends it an unfortunately negative cast; it may seem useful only to distinguish people for whom guardianship is an unavoidable necessity from those for whom it is not. Yet competency assessment can also play a very positive role - especially if the assessors (both formal and informal) have some awareness of the various informal practices and legal mechanisms by which one person may voluntarily give another the power to make decisions on his or her behalf. Assessors who have this knowledge can often help partially...

  12. Conclusion
    (pp. 177-180)

    This book began by considering incompetency as it manifests itself in the lives of people who suffer from it and in the lives of their friends and relatives. Many people feel a strong, deeply rooted, desire to help people whose incompetency has made them less able, or unable, to care for themselves. This book depends on, articulates, and serves that desire to care.

    But merely having a desire to care is not alone a sufficient basis for delivering the right kind and amount of care. Those who provide care to incompetent people must do so thoughtfully. Before acting, people should...

  13. Index
    (pp. 181-184)