[Mental competence and long term care: an uncomfortable relationship]

Area of Science:

• Medical Ethics
• Legal Medicine
• Geriatric Care

Context:

• Nursing home residents often face societal prejudice regarding their competency.
• Autonomy and self-determination are central to healthcare and nursing home ethics.
• Existing competency assessments may overlook crucial affective capacities.

Purpose:

• To analyze societal misconceptions about nursing home patient incompetency.
• To critique the dominant cognitive-centric view of decisional capacity.
• To propose an alternative 'capacity to value' model for assessing competency in nursing homes.

Summary:

• The study deconstructs five common societal delusions about nursing home patient incompetency.
• It contrasts the prevailing cognitive-focused decisional capacity model with a more holistic 'capacity to value' approach.
• The limitations of competency models for 'good care' in demented elderly are discussed, advocating for the 'ethics of care' perspective.

Impact:

• Promotes a more nuanced understanding of competency in geriatric care.
• Encourages a shift towards valuing affective capacities in ethical decision-making for nursing home residents.
• Highlights the importance of the 'ethics of care' framework for addressing complex moral issues in dementia care.