person's "decision-making capacity" 3 or, more broadly, whether the person has "impaired judgment." 4 The concerns about capacity and impaired judgment are so great that most model acts for assisted death suggest or require the involvement of a mental health professional to assess whether the person requesting assisted death is incapable or has impaired judgment. 5 For example, one proposal required a mental health professional to "evaluate the patient to determine that his or her decision is fully informed, free of undue influence, and not distorted by depression or any form of mental illness." 6 This article examines the issues of impaired judgment as well as the capacity to choose, and then to receive, PAD. Because the Oregon Death with Dignity Act, the only state law that allows PAD, has a provision for an assessment by a mental health professional about whether a person has the capacity to make a decision to request PAD and whether the person's judgment is impaired, 7 the article reviews dilemmas and suggestions for how assessments of capacity and impaired judgment can occur under the Act. 8 3 Capacity to form reasoned decisions is equivalent to "competence" but only a trier of fact (a judge or, if requested by the person, a jury) can make a legally binding determination whether a person is competent.
The Oregon 1994 Death With Dignity Act prescribes an evaluation by a psychologist or psychiatrist when the patient is suspected to be suffering from impaired judgment. Several attempts have been made to propose procedures for assessing end-of-life mental conditions and competence. The psychologist's role may include ethical considerations, protecting patients' rights to autonomy, ensuring competent judgment, preventing unnecessary suffering and appropriate diagnoses of mental disorders, and supporting family members and the health care team.
In this short article, the authors respond to the critiques of the four commentators on the original "Guidelines" article. They highlight areas of agreement and disagreement with the other authors in an effort to move the discussion forward.We appreciate the thorough review of our proposed guidelines by the panel of commentators. We were impressed with how carefully they scrutinized our review of the literature and the guidelines themselves. Their essays have added much to the philosophical, legal, and psychological discussion of this topic. Because of their prominence and experience, we were especially heartened with what we perceived to be an overall belief that the guidelines were both thorough and comprehensive.Although we agree with much of what the panel had to say about the issue of capacity assessment in general and our guidelines in particular, we want to take this opportunity to explore some of their assertions. We first review Youngner's commentary, "Bureaucratizing Suicide," as he is the only psychiatrist, and then address the views of the law professors in alphabetical order.
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