When the Mind Fails: A Guide to Dealing With Incompetency

Aging, Spring, 1996

According to the authors, one of whom is the founder of a competency clinic in Toronto, Canada: "The single most important concept discussed in this book is task-specific competency. Ordinarily people speak about competency as thought it is a single ability that people either possess or lack. But competency is not like a light bulb that is either on or off. Rather, it is a series of abilities, some of which can be present while others are absent. People do not have competence, they have competencies. Someone may be, for example, incompetent to drive a car but quite competent to invest his or her own money...."

The authors point out that "the best modern guardianship legislation (for example, the laws of Florida and Michigan in the United States and of Alberta in Canada), requires or encourages task-specific assessments and tailors a guardian's powers to correspond as closely as possible to the incompetent person's disabilities. For example, a guardian might be allowed to make financial decisions on a person's behalf but not decisions about the person's medical treatment... Even in the absence of such guardianship legislation, however, competency assessors bear an important responsibility to guard peoples' liberty. Unfortunately, assessors (and many others who deal with failing or vulnerable individuals) do not always recognize the degree or nature of this responsibility."

The cover of When the Mind Fails says the book "is for anyone who must face a friend's or relative's incompetency; fears becoming incompetency." Based on the authors' experiences at the Competency Clinic at the Bayerest Centre for Geriatric Care in Toronto, the book outlines the fundamental principles and basic practices of competency assessment. The book's preface states that "the Competency Clinic is a working hospital clinic that performs competency assessments and conducts researrch on competency and related subjects." The clinic was conceived by one or the book's authors, Dr. Michel Silberfeld, who is now the coordinator of the clinic's daily activities. The other author Arthur Fish, is a practising lawyer and a doctoral candidate at the University of Toronto Law School, and was a Legal Fellow at the clinic when the book was written.

The authors note that the clinic is "a multidisciplinary enterprise founded on the principle that competency is not simply a medical or legal concept but rather a complex phenomenon that has medical, social, legal and ethical dimensions... The clinic's members and fellows include a psychiatrist, a psyychologist, two philosophers, and two lawyers.

Chapter headings include What is Incompetency. Incompetency as a Human Problem, Assessing Competency. Informal Competency Assessment, Guardianship and Other Imposed Care, and Planning for Incompetency. Sprinkled throughout are case histories that illustrate the complexities of competency decisions.