¿Sé y puedo? Toma de decisión y consentimiento informado en los trastornos demenciantes: dilemas diagnósticos y jurídicos en Chile / Decision making and consents given by demented patients. Are they valid?

In Chile, more than 180 thousand people (1% of the population) have some form of dementia. The figure should increase to approximately 600,000 (3% of Chileans) by 2050. This disease poses major challenges to the society. One of them is the effective recognition of the autonomy and responsibility of the person living with this condition. This article aims to review the clinical assessment of competence, its agreement with the Chilean legal system and the challenges that the assessment of competence poses in clinical decision-making and the capacity of an individual make decisions, according to the new international obligations subscribed by Chile. It is concluded that inclusion is a pending challenge, reflected among other things, by the non-compliance with binding rules such as Article 12 of the Convention on the Rights of Persons with Disabilities, which affirms that persons with disabilities have the right to be recognized as a person everywhere, before the law.

Dementia and legal determination of capacity / Demência e avaliação de interdição judicial

ABSTRACT One of the consequences of dementia is the possibility of a guardianship proceeding that will deprive patients of legal capacity in taking decisions and managing their own assets. Objective To assess the legal capacity and guardianship proceedings in patients diagnosed with dementia. Methods Ninety-seven patients diagnosed with dementia and seen at a tertiary hospital were evaluated. Results Of these 97 patients, 60 (62%) were female. The mean age of the patients was 77.9 years; average schooling was 5.5 years. The main diagnosis was Alzheimer’s disease (73%): 16 patients were at a mild stage, eight at a moderate stage and 73 at an advanced stage of dementia. Only 28 patients had been legally declared incapable. Conclusion The large numbers of patients at an advanced stage of dementia, and the relatively few patients legally declared incapable show that legal issues in dementia are problematic.

RESUMO Uma das consequências das demências é a possibilidade da interdição judicial do paciente, retirando-lhe a capacidade jurídica da prática de decisões e administração de bens. Objetivo Avaliar a existência de capacidade jurídica e da interdição judicial em pacientes com diagnóstico de demência. Métodos Foram entrevistados 97 pacientes com diagnóstico prévio de demência atendidos no ambulatório de neurologia do comportamento de um hospital terciário. Resultados Dos 97 pacientes, 60 (62%) eram mulheres. A média de idade dos pacientes foi de 77,9 anos, e de escolaridade foi de 5,5 anos. O principal diagnóstico foi de doença de Alzheimer: 16 estavam em estágio leve, 8 em estágio moderado e 73 em estágio avançado da demência. Somente 28 pacientes apresentavam interdição judicial. Conclusão O elevado número de pacientes em estágio avançado de demência e reduzido número de pacientes com interdição indicou dificuldades em relação às questões legais da demência.

What are the boundaries of legal guardianship in Alzheimer's disease? An evidence-based update in the context of the Brazilian Civil Code

The Brazilian Civil Code, which came into force in 2002, established a functional criterion for guardianship proceedings and introduced the concept of “limited guardianship,” applied to cases in which incapacity to exercise civil rights is partial. With population aging and the growth in the number of older people with cognitive impairments, such as Alzheimer’s disease (AD), the need to invoke legal remedies against elder abuse increased; however, difficulties in assessing capacity still lead to a majority of decisions in favor of plenary guardianship. The present article compiled data on capacity in AD subjects. The varying degrees of decision-making impairment at different stages of AD might be compatible with limited guardianship in milder cases of the disease.

Civil competence assessment of the mental disorders involved in compensation of personal injury / 法医学杂志

OBJECTIVE@#To seek and ascertain indicators that can be used in the civil competence assessment of the mental disorders involved in compensation of personal injury.@*METHODS@#A retrospective study was made on the data related to the interviewee's mental status assessed by forensic experts during the period from 2003 to 2005 in Institute of Forensic Science, Ministry of Justice, P.R.China. The 6 indicators, including awareness of situation, factual understanding of issues, appreciation of likely consequences, rational manipulation of information, functioning in one's own environment, and communication of choice, were graded and statistically analyzed using SPSS 11.5 software.@*RESULTS@#The 6 indicators correlated well with the assessment of forensic experts ,with the related coefficient between 0.632 and 0.876, and the inter-related coefficient among the 6 indicators between 0.575 and 0.911.@*CONCLUSION@#The 6 indicators could be used for the civil competence assessment and may also be taken as the basis for further standardization and quantification of civil competence.

Schizophrenia and jurisdictional identifications of mental diseases / 法医学杂志

Schizophrenia is the most common in forensic psychiatry. The motive, the style and the consequence of any schizophrene's misdeed have its own particularity. So schizophrenia is significant in the forensic practice. The characteristics of schizophrene's misdeed and the peace breaker's responsibility, competence to stand trial and to serve a sentence werereviewed.

La evaluación de la capacidad de la persona: en la práctica actual y en el contexto del consentimiento informado / The evaluation of decision making capacity in health care and its relationship to informed consent

The decision making capacity of patients will acquire special relevance with the introduction of informed consent in clinical practice and the new normative that will appear in the future when the bills about health services are approved in the Congress. This paper reviews the concept of decision making capacity in the context of health care and its legal background in Chile. The main problems that arise from the comprehension, use and assessment of decision making capacity, are analyzed. The assessment of this capacity is, in most cases, subjective since there are no criteria, protocols or standards to be used. In courts of justice, the exercise capacity assessment is requested to experts. These specilized physicians will evaluate the mental health of the subject and its implications in the capacity to make decisions. In practice, it is difficult to integrate the concept of capacity from the law or health care perspective. It is concluded that the elaboration of criteria, standards and procedures to evaluate the decision capacity of patients, is mandatory.