ETHICAL DILEMMA A question of competence

Patients should be allowed to make decisions for themselves if they are mentally competent. However, the standards of mental competence vary, depending on aspects of the decision and on the patient. Decisions that are complex require a high level of competence. Decisions in which the consequences are severe may also require a high level of competence and require that the examiner is more certain about the level of competence that the patient exhibits. There are some decisions in which patients require specific cognitive attributes (such as long-term or short-term memory). We report our experience in dealing with an elderly woman who expressed a desire to return to her home after respite care, although evidence of self-neglect suggested that permanent placement in an aged-care hostel might be more appropriate.