Competency
As people age and are confronted with illnesses and diseases that can effect the capacity for decision making the question of competency arises. A person's decision making ability can be impacted by short term factors, such as post-surgical delirium (which are quite common in older adults who undergo general anesthetic), or by long term factors such as progressive dementia.
The subject of competency comes up most often when an important decision needs to be made (e.g., consent for an important medical procedure or the decision to continue to drive) and there is some dispute about whether the person in question can make the determination appropriately. Today, in most states there are provisions that allow an individual to designate a person, or agency, to make these important choices for them if they are unable to make them for themselves. The process of assigning another to make important decisions for an individual is most often referred to as a Power of Attorney. An individual can also make some important decisions ahead of time using a Living Will or POLST form.
When there is a dispute between an individual's choice and what medical professionals, or family members, believe is in the person's best interests the question of competency can be brought to the courts. In most states a judge is the only entity with the power to supersede an individual's right to choose by declaring the person incompetent to do so. In making this important determination a judge will often rely on the expert testimony of medical professionals. Medical doctors, and other healthcare professionals, can play an important role in helping the judge make these difficult decisions. In the case of older adults it is often helpful to have neuropsychological testing to help delineate the person's cognitive strengths and weaknesses.