Clinical determination of mental competence. A theory and a retrospective study
M. P. Alexander
Aphasia Program, Braintree Hospital, MA 02184.
In an attempt to establish a method for determination of mental competence,
a two-part investigation was undertaken. First, a model for mental
competence was devised that would be applicable across a broad range of
neurologic disorders; this model was based on a patient's ability to make
complex decisions. Second, a retrospective analysis of competence in 92
inpatients on a neurobehavioral service was carried out. The model was a
useful way to view competence, at least in this population. Competence
could be classified as operational, limited to a single cognitive domain,
or as general, cutting across all domains in a way for which no
compensation could be devised. The results suggest that a model of
competence based on analysis of individual cognitive operations will
provide a sound clinical approach to a common problem that is presently not
well characterized.
