Assessing Psychiatric Patients' Competency to Agree to Treatment Plans
Kenneth D. Galen M.D.1
1 Massachusetts Mental Health Center, Harvard Medical School, 74 Fenwood Road, Boston, Massachusetts 02115
The issue of therapists' liability for patients who commit suicide may depend on whether courts view the suicidal patient as competent to decide to follow or not follow an agreed-upon treatment plan. Therapists have not been found liable for malpractice when courts have viewed a patient's decision not to seek help when feeling suicidal as being voluntary rather than reflecting global incompetence due to mental illness. The author offers practical suggestions, including sets of specific questions, for assessing and documenting a psychiatric patient's competency to agree to a treatment plan. An important element of the procedure is direct assessment of the patient's understanding of the risks of withholding information from caretakers and the benefits of providing it. Such competency assessments can facilitate clinical management of patients and can also help reduce the risk of malpractice liability resulting from patients' suicide.
Note:
The author acknowledges his indebtedness to Thomas G. Gutheil, M.D., for critical comments and helpful suggestions, to Victoria Alexander for editorial comments, and to Debra S. Morley for assistance in manuscript preparation.
