User:Esaiter/Competence (law)

United States

Competence to make treatment decisions

In the United States, an individual must be deemed competent to provide informed consent for medical treatment. If someone is incompetent, they cannot provide informed consent, and another decision-maker (such as a guardian or health care proxy) may be identified in their stead. Competence to make treatment decisions stems from legal precedent about the right to refuse psychiatric medication and treatment. In the context of informed consent, most adults are assumed to be competent unless otherwise specified. Should the adult suffer from severe mental illness or intellectual disability, their competence may be questioned. Still, adults from these more vulnerable populations are not incompetent by default and their competence should be evaluated on a case-by-case basis. There are specific tools that a psychologist may use to evaluate competence to make treatment decisions, such as the MacArthur Competency Assessment Tool-Treatment.

If an individual's competence to make treatment decisions is questioned, their understanding, appreciation, and decision-making process may be evaluated.  

Understanding

A patient should be able to understand any relevant information about their treatment or medical condition which would be disclosed to them during informed consent. If a patient does not possess the ability to understand the information disclosed to them, they may not be competent to make treatment decisions. Some adults who may lack this ability to understand might be patients who suffer from amnesia, dementia, or those with intellectual disabilities.

Appreciation

A patient should then be able to not only understand information about their treatment or medical condition, but also appreciate how that information may apply to them. This aspect is more than understanding the information in the abstract; the patient should be able to appreciate the consequences of a) consenting to the treatment, b) investigating alternate treatment options, or c) refusing the treatment, and how they would be directly impacted. A patient who experiences delusions which are out of touch with reality may understand that antipsychotic medication is a traditional treatment for schizophrenia, but believe that in their case, they are not mentally ill and taking this medicine would make them catatonic. In this case, the patient lacks the ability to appreciate the consequences of their decisions.

Reasonable decision-making process

This aspect of competence is related to the cognition or thought-process underscoring the patient's decision. The patient must be able to rationally weigh the benefits and risks associated with their medical condition, consenting to treatment, assessing alternative treatments, and/or refusing treatment.. An evaluator may question a patient's competence if some substantial consequence (e.g., limb amputation) is thought as less important than something relatively minor (e.g., hair loss). If the decision to refuse treatment appears to stem directly from mental illness, this may indicate a patient's decision-making process is not rational or reasonable.

Competence to Testify--Kristen's stuff starts here :)

In the United States, individuals who want to testify as a witness in a trial are generally found to be competent unless proven otherwise. However, questions of competency can be raised regarding any person who might issue a testimony (e.g., defendant, witnesses, experts) and can occur in both criminal and civil trials. Groups most likely to trigger a competency issue are children (especially under 10 years-old), people with intellectual or developmental disabilities, people with mental illnesses, and people who have abused substances. Before 1975, certain populations (e.g., children) had to prove competency in order to testify, however this changed after the addition of Rule 601 in the Federal Rules of Evidence which states “every person is competent to be a witness, except as otherwise provided in these rules.” This sets a standard that individuals cannot be excluded from testifying based off of age, cognitive impairment, and/or mental illness alone. An individual may be deemed incompetent to testify as a witness if their testimony is found to be irrelevant or misleading, or if the witness is unable to be truthful It is important to note that witness competency is different from credibility. Competency refers to a witness’ capacity to accurately relay the details of the event, but credibility refers to a witness’s likelihood of truthfulness in their testimony. While competency to testify is determined by the trial judge, the credibility (e.g., truthfulness) of that testimony is weighed by a jury .

Criteria for Determining Competency

Competency to testify is decided by the judge and rarely requires formal evaluation because it is a low threshold to meet and judges often use their own discretion without expert input. Instead, judges use several basic criteria to decide if a witness has the capacity to testify (ability to observe, ability to remember, ability to communicate, and ability to remain truthful).

Ability to observe

Witnesses must have been able to observe the event which they are testifying about. This standard is usually met, unless the witness has visual or hearing impairments which make observing the event difficult (see Williams v. State (2010) where witness testimony was called into questions because of their visual impairment). Research with children and observational capacity has found that even though young children often struggle to understand and make meaning from the complex interactions they witness, it does not inhibit their ability to report what they observed

Ability to remember

Research suggests that for witnesses, the two biggest problems that might interfere with their ability to remember the event are time and age. The more time that passes between the event and their recollection, the more difficult it will be for them to accurately recall the event. Also, young children are more susceptible to outside influences and have a more difficult time remembering the details of the events compared to older children

Ability to communicate

This is related to a witness's ability to utilize language and organize the details of the event by time and space. This is more difficult for young children who do not have a mastery of the language and may have trouble recalling event details in order. For people who have physical or developmental disabilities, accommodations may be made based on the court's discretion. For example, in People v. Miller (1988), a speech therapist was permitted to translate for a victim with cerebral palsy who had difficulty testifying

Ability to remain truthful

Witnesses must be able to distinguish between truth and lies and swear an oath to tell the truth in the courtroom. Most people, children included, understand that they have to tell the truth on the witness stand, even though they might have different motivations for why they want to tell the truth. Research shows that even young children are able to differentiate between truth and lies, and do not lie any more frequently than adults do.

Competence to Consent to Search or Seizure--Lisa's content begins here

In order to obtain evidence in criminal cases, law enforcement can conduct searches and/or seizures of people's things. A search is when law enforcement personnel are looking for evidence that might be useful in a case. A seizure is when law enforcement personnel actually take items from a person or scene to further investigate their case. The Fourth Amendment of the United States Constitution states, "The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized."

Law enforcement can request to search a person or location if they are given voluntary consent by the person in question. Law enforcement may also conduct a search if they have a warrant issues to do so. Voluntary consent is considered to be consent given that is free from coercion.