Competency to refuse treatment, as well as consent to treatment, requires the utmost attention and consideration since the stakes can be life or death. Such examinations explore (1) a person’s awareness of one’s condition (2) a person’s awareness of the nature of the proposed treatment or procedure (3) benefits, side effects, and risks of that treatment or procedure (4) treatment or diagnostic alternatives (5) benefits, side effects, and risks of alternative treatments (6) impact of doing nothing.
As in assessing other forms of competency, the forensic psychiatrist assesses the individual’s mental status, intellectual and cognitive functioning, memory, understanding, malingering and personality in how they relate to the refusal or consent to treatment. The expert psychiatrists of The Forensic Panel, in addition to being the most highly qualified of objective examiners, treat patients themselves. Their experience in treating and evaluating patients and appreciation for the context of hospital-based medicine, combined with the rigorous peer review of their work by The Forensic Panel, enables conclusions on competency to refuse treatment to reflect a higher level of medical certainty.