Questionably Competent Long Term Care Residents - Problems and Possible Solutions Ad Hoc Committee for the Study of Problems of Questionably Competent Long Term Care Residents, Washington D. C., American Health Care Association, 1982.
With the exception of those major decisions involving the courts, such as the right to die or establishment of a conservatorship, the mechanism for appointment of and actions by surrogate decision makers are largely done on an "ad hoc" basis. Court declared incompetency is an all-or-none condition and does not allow for competency at one time and not another, dependent upon an individual's condition or the significance of the decision involved.
The result is a 50 page report including an extensive bibliography and appendices. The paper explores patient, family, provider and public concerns; and the problems of defining "incompetency." The committee developed criteria for evaluating due process systems and evaluated present decisionmaking systems against those criteria; taking into consideration that the decision to have a patient attend an activity program, for example, would not require the same due process as would be applied to the decision to have elective surgery.
Appendix A is an extensive six-page bibliography. In Appendix B, two recent Supreme Court cases involving the constitutionality of some state procedures raise questions about the decision-making rights of a patient who has some degree of mental impairment but has not been declared incompetent by the courts.
This is a scholarly written paper, prepared for the purpose of stimulating more study and the hopeful development of better solutions. It is recommended to those who desire better understanding of difficulties with present surrogate decision-making mechanisms or to those interested in development of a better due process system than presently exists for the partially competent long-term-care resident.