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Determination of Competency for High-Gravity Life-Death Decision-Making

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Abstract

Just as the number of developed countries now legally permitting physician-assisted suicide (PAS) continues to grow, so too does the number of legal terms and definitions of medical assistance in dying and associated decisional capacity standards, illustrating the diversity of opinions on this topic. Of particular concern is the lack of a standard framework for clinical assessment of an individual’s competence to make this life and death high-gravity decision. This article provides context by reviewing background literature, current terminology, definitions, and evaluation models, as well as legislation regarding competence determination for choosing physician-assisted suicide and medical assistance in dying in general. A review of relevant current research is presented, with suggestions for future research and practice advances to fill the gap of much needed elucidation of this intensely debated topic. Finally, we note considerations for the development of a forensic assessment framework to assist professionals who may find themselves in the position of having to assess an individual’s competence in relation to this high-gravity decision-making process. Our conclusions are limited by current available evidence and observations, which may lack scientific precision of methods for determination of decisional capacity, and have limited validity, reliability, or fairness, thus increasing the potential for bias and abuse of vulnerable persons.

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  1. The Cortex: Centre for Advanced Assessment, Vancouver, BC, Canada

    I. Z. Schultz, A. M. Stewart & A. A. Sepehry

  2. Educational and Counseling Psychology, and Special Education, University of British Columbia, Vancouver, BC, Canada

    I. Z. Schultz

  3. Clinical & Counseling Psychology Programs, Adler University (Vancouver campus), Vancouver, BC, Canada

    A. A. Sepehry

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Schultz, I.Z., Stewart, A.M. & Sepehry, A.A. Determination of Competency for High-Gravity Life-Death Decision-Making. Psychol. Inj. and Law 12, 266–280 (2019). https://doi.org/10.1007/s12207-019-09361-x

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