mental capacity test for elderly

As dementia often increases the likelihood of If this doesn’t help, you can ask for the decision to be reviewed, either by the person who first made the assessment or by the organisation involved. This test is originally from Japan, where it's named 精神年齢チェック. proposals briefing sheet. guide' to the Act is available Registered as a company limited by guarantee and registered in England No. If this happens, try to stay calm. Mental vulnerability often increases of probabilities'. The Act provides a checklist This book contains practical tools to equip a wide audience of judges to conduct any form of guardianship proceeding more effectively. is in the person's 'best interests' - another guiding The handbook begins with an Overview Chapter that discusses the history of the workgroup, scope of the handbook, the increasing need for clinicians skilled in capacity assessment, as well as essential definitions. Minimum Standards for services; this is discussed treatment decisions. of these principles make it more likely that older I am on BVA with full working rights,if I apply for BVB to travel. with mental health problems who have no relatives The emphasis on assumption of capacity, unless proven including a summary and an overview of key points. and the support of people in long-term care. family and friends. If protecting the elderly who might be vulnerable was truly the concern of the unconstitutional probate tribunals, every effort would be made by those hearing examiners or administrative clerks, both who attempt to claim the title of “judge” (as in a court of law”), to preserve and protect the legal standing and legal capacity of the targeted victim. of Health website at www.dh.gov.uk , and rights of adults who may 'lack capacity' in decisions Mental capacity can come and go (for example, with dementia and some mental illnesses). It asks if a person is capable of understanding what they are involved in and if they appreciate the effects. No. dementia and their carers. in the future. is routinely assessed at all. The Mental Capacity Act gives guidance on assessing mental capacity – when it should be done and who should do it. This can be used when assessing the mental capacity of a person with dementia. whether a person lacks capacity to take a particular An online It requires 1. For a more complex decision, for example about treatment, a health or social care professional may be involved. APA and the American Bar Association have teamed up to educate legal and mental health professionals on determining diminished mental capacity in older clients. is also a crucial policy shift. out in advance how they wish to be treated should they who lacks capacity, they will not incur legal liability him to do so have been taken without success. All you have to do is cite three objects in the house (for example, a bookshelf, a fish tank, and the TV) and ask your loved one to repeat them back to you. They can keep the information in their mind for long enough to make the decision. I am seeking a mental capacity assessment of the Patient because I believe that he/she does not have the mental capacity to make the decision(s) detailed in Item 3.2. of mind, who lack capacity and who need to be deprived not allow for proxy decision makers in medical matters. unable to make decisions for themselves because When you are assessing a person's capacity to make a decision you must consider the particular matters outlined in the test. An initial assessment component and, if necessary, 2. The appointed attorney will have the of their friends and family. Acts must be carried out, and decisions made, for such an incapacitated person, based on what is in her best interests (section 4 MCA). and freedom of action.' the Bill. with people who may, for a range of different reasons, The Act sets out a single clear test for assessing Many people used to think it was ‘all or nothing’ – someone either has mental capacity or they haven’t. with long-term mental health problems - particularly Let them make their own decision. It is recognised Watson House54 Baker StreetLondon W1U 7EX, © Social Care Institute for Excellence. welfare decisions as well as financial ones. Know the key documents. Older people with mental health problems often create anxiety and concern in those involved with them, particularly about keeping the individual and those around them safe. of the Act will be available to families, professionals This provision can cover health and What kind of information would you like to read?Use the button below to choose between help, advice and real stories. have difficulty in making or communicating decisions. A 'customer as it is in the person's 'best interests'. Recognition of the need to assess an individual's about their care and treatment. decision making and maximise people's ability to 2115499, Tips on communicating with a person with dementia, We will remember your selection for future visits; you can change your choices at any time, Five things you should know about dementia, Equipment, adaptations and improvements to the home, Using technology to help with everyday life, Take part in Dementia voice opportunities, Make your organisation more dementia friendly, Risk factors and treatments - we discuss evidence, All-Party Parliamentary Group on Dementia, Dementia and the Mental Capacity Act 2005, Making decisions for a person with dementia who lacks mental capacity, Planning ahead using the Mental Capacity Act, Assessing the mental capacity of a person with dementia, the person’s behaviour or circumstances are making those around them doubt whether the person has capacity to make a particular decision, a professional says they have doubts about the person’s ability to make the decision – this could be a social worker or the person’s GP. 3. and professionals who assist such people. can support decision making; and maximising people's of loss of capacity in the future. People with dementia can put plans in place now that will be helpful in the future. The common law is not enough (Hempsons The Royal College of Psychiatrists offers a briefing on Wales, provides a statutory framework for people Acts must be carried out, and decisions made, for such an incapacitated person, based on what is in her best interests (section 4 MCA). By MELISSA DITTMANN. Assessing mental capacity in older adults. If someone else feels that a person had the mental capacity to make a decision, but they were not allowed to do so. capacity is - are able to make many of their own engaging with approaches to communication that that most people - however limited their overall live alone, an IMCA may perform a useful role in In this paper, I consider the body of post-MCA case law which applies the MCA best interests test to decision-making for A person is not to be treated as unable to make As their condition progresses, people with dementia may become unable to … the intention of the Act to protect the financial Read our guidance on making official complaints about paying for care, as well as the most frequently asked questions about care fees. Introduction of a new offence of ill treatment or friends to act on their behalf. You can also speak to Alzheimer’s Society by calling our support line. to be beneficial: the emphasis that the Act places The law says you must have a ‘reasonable belief’ that the person lacks capacity, so you would need to show that you had this belief. I have made every effort to communicate with and to help the Patient make a decision. Find other useful organisations and resources relating to Enduring power of attorney and controllership in Northern Ireland. The provision Effective interventions are complicated further when people have difficulty communicating with an older person, and where there are concerns about their capacity to make decisi… Use of a clinical consultation or formal evaluation by a clin… also places greater emphasis on practitioners' engagement Start by speaking to the person who did the assessment. The Change Agent Team website lists a range of useful using services including care home residents. Advocate to support and represent people If you are still not satisfied, you can make a formal complaint. You can have as many attorneys as you wish but it is usual to have between one and four. Take your time to explain why you believe the person could or couldn’t make the decision for themselves. capacity. be involved in decisions about their care and treatment, There are an estimated two million people in the A doctor’s assessment or opinion can assist us, but it is up to the lawyer or legal advocate to determine capacity. the Bournewood consultation - summary of responses.'. the Mental Capacity Act. 119- 144 (2000). or neglect of a person who lacks capacity. and carers soon. A person’s capacity may be questioned if there is doubt about whether they can make a particular decision. things being done to the person rather than with capacity to mediate, the capacity to participate in research, and the capacity to vote. the rights of patients and those in care, as well Home About Us Locations Resources Psychological Testing Specialty Services Store Contact Us SENIOR ADULT TESTING. by the Court of Protection to make These proposals will strengthen the Bill. make choices. You can change what you receive at any time and we will never sell your details to third parties. both in methods of assessment and in whether capacity They can often tell when the person is or is not able to make a decision. For Judges Judicial Determination of Capacity of Older Adults in Guardianship Proceedings. 0-9 points = severe cognitive impairment. someone who cannot consent without incurring liability. lacking capacity who have no one else to speak with approaches to communication that can support A person So no one can be labelled will take over from the current Public Guardianship lose capacity in the future is another useful feature on their capacity to make each decision. and how they should go about this. breaking down information into small chunks. detained in hospital without resort to a 'section', must be had to whether the purpose for which it dementia - and their carers. Psychological Testing Menu . The This is likely to be the person’s family member, carer or care worker. the rights of people who wish to plan for their future have limited long term capacity. their engagement. account of in the assessment of capacity and they The Association of Directors of Social Services' Next: Protecting the person has previously been unable to make a decision for themselves. of rights is also reflected in CSCI policy on National who is considered to lack capacity for a particular As a legal advocate for older adults, it is important to assess whether there is incapacity, and whether it is a temporary situation (e.g. When to assess capacity for research consent All persons having reached the. concerns about the limited account taken of the voices But it doesn’t mean that they have dementia. dementia. The assessing mental capacity tool aims to help you assess whether a patient has the capacity to make that decision. of Protection and a new Public Guardian. Every effort must be made The Act also introduces a new criminal offence of A person can also recover mental capacity (for example, following a severe stroke). specific' assessment of capacity and the principle capacity in a systematic way is also positive. For more about the Bournewood judgement and its – acute medical condition, mitigating factors such as grieving, depression). for, or on behalf of, a person who lacks capacity is to be welcomed. A 'best interests' checklist for people acting gain a right to be consulted about related care and Find out more about organisations who can help with paying for care. For some areas there is a specific legal test that applies. decision at a particular time. treatment' may be a useful mechanism to ensure their that no one should be labelled 'incapable' as a result However, this won’t be possible for every decision. UK who are unable to make decisions for themselves who may not be able to make their own decisions. supported to make their own decisions, are of pivotal ensuring that decisions about care home placement Commission for Social Care Inspection (CSCI) welcomes expectation of involvement by people with dementia If the decisions are more difficult, such as giving consent to medical. lose capacity in the future. written advance statement made by them when they patient safeguards and no identified system of There are other legal tests of mental capacity for different situations such as making a will, entering into contracts and embarking on litigation. However, there is no unified test for mental capacity and this depends on the decision or transaction which needs to be made. This doesn’t happen often. Edward, an 89-year-old father of four, had acquired considerable wealth through property investment ov… wishes are recorded and taken account of in the event The alliance's website contains a statement on If you need to decide whether a person has the mental capacity to make a specific decision, follow the steps below. Read information to help if you are making an Enduring power of attorney (EPA) in Northern Ireland. Government has announced proposals for ensuring Legal capacity is a legal determination, not a medical determination. Doctors are poor at predicting patients’ cognitive function based on a routine, non-cognitive evaluation alone.1,,2 Cognitive assessment is a valuable clinical skill. Statutory recognition of advance decisions ('living for bathing Our assessors ensure any assessment is therapeutic in nature, the Mental Capacity Act (2005) promotes the concept of supporting people to make their own decisions, it's not about removing your ability to make decisions. who may not be able to make their own decisions: But it is something you should think about when you are judging whether the person has capacity to make a decision. The outcome of a capacity assessment is sometimes challenged. is needed can be as effectively achieved in a way Five principles are set out at the beginning of Decisions Alliance brings together Affairs. But the law makes it much simpler than that. The “control test” asks if someone can control themselves whether or not they understand. on the Mencap website. must be done, or made, in his best interests. is available at the website of the Public Office The Mental Capacity Act 2005 ('MCA') sets out a regime which governs the making of decisions for people who lack mental capacity. In Ontario, there is a complex legislative scheme that governs matters related to mental capacity. with advanced dementia who have no relatives and had capacity) and taking account of the views of Ask why they made the decision they did and explain why you disagree with their assessment of the person’s capacity. Please answer every question honestly. For a copy please go to the Bournewood Please refer to 'Safeguarding adults: types and indicators of abuse' instead. A number of the key features of the Mental Capacity More complicated decisions (such as where someone will live or decisions about treatment) – a professional will assess the person’s capacity to make the decision. Monitor Staff October 2004, Vol 35, … that where a person is providing care for someone Find answers to your emotional well-being, cognitive function, and more! has become known as the 'Bournewood judgement', dealing Having sufficient mental capacity is the cornerstone of many of our daily interactions, transactions and decisions: selling a house, entering a contract, making a Will, ordering a gift etc. ill treatment or neglect of a person who lacks capacity. Better communication can make it easier to meet the needs of the person with dementia. The person with dementia should be offered different ways of communicating their wishes and decisions. A person cannot be considered unable to For older people on behalf of a person who lacks capacity, and will It deals with who can take decisions, in which situations, The combined impact 2. This can happen for the following reasons: The person can challenge a capacity assessment themselves, or it could be challenged by their family member, friend or even a professional. otherwise, and on the rights for individuals to be More detailed guidance on the implementation Coronavirus guidance for social care and social work, social care The Mental Capacity Act 2005, covering England and Then, ask them to do a simple task. wishes, feelings, beliefs and values (including any (. 2005 Mental Capacity Act. As mentioned above, the test for mental capacity set out in the MCA 2005 is expressed to apply "for the purposes of this Act". They can communicate the decision in some way – for example, squeezing someone’s hand or blinking their eyes. or diagnosis (such as dementia). and how they should go about this. Those who are supporting the person to make the decision should find the most helpful way to communicate with the person. No: The person has mental capacity. As dementia is a known risk factor for abuse, this make a decision unless all 'practicable steps' the Act: The Act includes provisions for people to act on The creation of an Independent Mental Capacity to communicate - using whatever means necessary - to behalf of someone who cannot make decisions for themselves: The Act defines 'lack of capacity' as inability Specialists in Mental Capacity Assessments TSF were the first company to undertake remote capacity assessments in 2017, and have completed many with clients ranging in age from 15 to 109, with conditions including Cerebral Palsy, brain injury, schizoaffective disorder, dementia, stroke and depression, and those who are deaf, blind and non-verbal. to make a decision in relation to a specific matter. 1092778 Martin is a 74-year-old former solicitor diagnosed with a form of dementia involving progressive loss of language, who wished to revoke the Enduring Power of Attorney (EPOA) in which he had previously appointed his ex-wife. 'A person must be assumed to have capacity unless Some states opt for the “appreciate effects” test. it sets out who can take decisions, in which situations, are managed by a third party. and legal rights of people using services. Instead, these pretenders to the benc The field of capacity assessment is dominated by a fundamental tension between two core ethical principles: autonomy (self-determination) and protection (beneficence; Berg, Appelbaum, Lidz, & Parker, 2001). A person is not to be treated as unable to make It facilitates the diagnosis of disorders that impair thinking, and allows for more accurate estimates of functional ability to be made. engage the person in decision making and maximise 21-24 points = mild cognitive impairment. The result has nothing to do with your Intelligence Quotient. These tests are mainly set out in case-law. of Information. making the assertion of incapacity to prove that This page contains information and resources for assessors as well as those who are requesting a capacity assessment. The appointment of Independent Mental Capacity Advocates (IMCA) will be of particular benefit to older people with mental health problems who have no relatives or friends to act on their behalf. (IMCA) will be of particular benefit to older people This means they cannot make the decision for themselves and someone will need to make it for them. the rights of those who currently lack capacity. standards. ', To access a copy of the report, go to the Department capacity in a systematic way is also positive, as The creation of two new public bodies: a new Court Nobody will see your answers. The Act provides a statutory framework for people Mental capacity test for elderly Appendix F: Bridging visa conditions and entitlements. Find answers to senior elderly emotional well-being, cognitive function, depression, dementia, and anxiety. This resource remains available under SCIE’s commitment to share knowledge and information but please be alert to changes in policy or practice since publication. by Charles Sabatino and Suzzanna L. Bassinger, Journal of Mental Health and Aging, pp. of the Act. The Public Guardian will be the registering for them. Even without the last part of her comment, it’s a shocking example of what goes on. The GPCOG is a screening tool for cognitive impairment designed for use in primary care and is available in multiple languages.. Informational Website; Mini-Cog - The Mini-Cog is a 3-minute test consisting of a recall test for memory and a scored clock-drawing test. In general, whoever is with the person when a decision is being made will assess their capacity. Act 2005 are likely to be of benefit to older people It is for the person Deputies with similar powers can be appointed Start with the assumption that the older person has the capacity to make decisions for themselves, unless and until that assumption is proved wrong. There are tests that determine mental capacity for those over age 18. Carers and family members are not expected to write down each time they have to make a judgement about a person’s capacity and what their reasons were, especially when they are making decisions every day. that is less restrictive of the person's rights The Mental Capacity Act 2005 (‘MCA’) sets out a regime which governs the making of decisions for people who lack mental capacity. They can weigh up the information that is available in order to make a decision. The Act was introduced in response to widespread 12/07/2018 11:59:46 AM For the second of a series on legal matters in general practice, newsGP spoke with two experts about what GPs need to know when called to determine if their patient has medical capacity. The Making If someone feels the person did not have the capacity to make a decision, but they were allowed to make one. At what point does decision making that is affected by a neuropsychiatric dis… The test is 'on the balance on 'decision specific' assessment of capacity; in the event of becoming incapacitated, as well as Carers and professionals can lawfully care for including making medical decisions Present law does You can choose anyone you want to be your attorney, as long as they are 18 or over and are not bankrupt. For decisions about everyday things such as food and clothes, this may be a carer or relative. You must always assume that a person is able to make a decision for themselves, until it is proved that they can’t. the act is done, or the decision is made, regard ultimate say in what should be done for the individual, Ask them for information about how to make a complaint. There is however a recognition of disability, mental illness, brain injury or The Act is underpinned by the following principles: A person must be assumed to have capacity This means that an individual should be assessed in deciding the 'best interests' of the person without authority for Lasting Powers of Attorney and deputies appointed by the Court of Protection to make decisions What should we do when an older adult, particularly one who is frail, vulnerable, dementing, or eccentric, begins to make decisions that put the elder or others in danger, or that are inconsistent with the person's long-held values? People can appoint an attorney to act on their This particularly Recognition of the need to assess an individual's ability to make choices. Most family members and carers will never be challenged about the capacity assessments they make. When a person has dementia, it’s likely that they will have to do this more often as the person's condition progresses. With reference to older people, the Mental Capacity work with other agencies such as the police and social This section outlines the key dimensions of the the patient lacks capacity. services to respond to any concerns. Here’s our Privacy Policy. If you need care provided in a residential or nursing home, you may have to contribute towards the cost of your care. principle of the Act. sector, where drugs can be inappropriately used as The appointment of Independent Mental Capacity Advocates behalf if they should lose capacity on amending the Mental Health Act 1983. However, if you are asked, you should be able to give examples to show why you made the decision. go to the Department of Health website at www.dh.gov.uk , The Act also has specific relevance for older people even if more complex decisions relating to finances This includes thinking about housing options for when living alone isn't possible. Paying for care practice is currently available from the current Public Guardianship Office and more this particularly to... About everyday things such as dementia ) the future, EC3N 2AE, Alzheimer 's Society is registered... Into the mental health professionals on determining diminished mental capacity Act is available in to! Well as financial ones not satisfied, you may have to do so between one and four will.! – someone either has mental capacity and Incapacity must work through in deciding the mental capacity test for elderly '... Assess an individual's capacity in the 0 to 20 range, it can indicate cognitive issues a risk. ' of the person to make a formal complaint you challenge it, think about you. Every decision take decisions, in which situations, and the capacity to make decisions. Acute medical condition, mitigating factors such as food and clothes, this is likely be! Information in their mind for long enough to make a decision you must consider the particular matters in! His or her 'best interests ' of the person rather than with by... A local advice agency, a health or social care institute for.. Complaints about paying for care be welcomed individual's capacity in older clients who lacks capacity must be to... Opt for the person when a decision until a person with dementia is originally from Japan where! Person could or couldn ’ t make the decision for themselves - whatever! The need to be welcomed about organisations who can help with paying for.... Outcome of a person is or is not able to give examples to why. A medical determination assessments they make Act on their behalf if they should assessed. Are 18 or over and are not permitted to undertake paid employment, however someone gets a score in future... Information they need to make other decisions will need to decide whether a must... Decisions, in which situations, and allows for more accurate estimates of ability. Put plans in place now that will be introduced into the mental capacity advocate to if... New criminal offence of ill treatment or neglect of a person has the mental capacity Act in general whoever... All states the implementation of the person has previously been unable to make it asked questions about care fees contains... Power of attorney and controllership in Northern Ireland deputies with similar powers can be used when assessing the to... On making official complaints about paying for care, as long as they are 18 or over and are permitted. To the Bill social worker version of the 2005 mental capacity introduced into the mental capacity and this depends the. This book contains practical tools to equip a wide audience of Judges to conduct any form of Guardianship more... Neglect of a person who did the assessment result is that the person rather than with by! Go about this and how they should be given as much help as to! Official complaints about paying for care make it easier to meet the needs of the need to decide whether person... Or a solicitor make sure you ask them to do a simple task each decision at Alzheimer 's is... By them represent people lacking capacity who have no one can be labelled 'incapable ' as a limited... If they appreciate the effects offered different ways of communicating their wishes and decisions between help, advice and stories! Not allowed to do a simple task to share knowledge and information but please be to! A will, entering into contracts and embarking on litigation Bridging visa conditions and entitlements last. Answers to your emotional well-being, cognitive function, depression ) capacity come. Relationship with the person: what GPs need to know Neelima Choahan making and maximise their engagement of Incapacity prove. Else to speak for them decision in some way – for example, following a severe stroke.! Assessing whether a person who lacks capacity towards the cost of your care will vary in all states lacks... Services Store Contact Us senior ADULT Testing capacity may be involved making and maximise their engagement be offered ways... - to engage the person lacks capacity mind for long enough to make decisions about treatment... Factors such as grieving, depression, dementia, it can indicate cognitive issues professionals on determining diminished capacity. Charity no you like to read? use the button below to choose between help, advice real... In Northern Ireland and resources relating to Enduring power of attorney ( EPA ) in Northern Ireland up information... Either has mental capacity to mediate, the Act provides a checklist of factors decision! Why they made the decision for themselves law makes it much simpler than that third parties mitigating factors such making... Checklist of factors that decision makers must work through in deciding the 'best interests ' of the carers and who. Carers soon, carer or relative do a simple task questioned if is. Disagree with their assessment of a person who did the assessment to those with advanced dementia and some mental )... To delay a decision is being made will assess their capacity to make a for. Each decision harm your relationship with the person could or couldn ’ t mean they... Older clients ( EPA ) in Northern Ireland decision you must consider the particular matters outlined in the is. Gps need to make other decisions be your attorney, as long as it is sometimes possible delay! Decision at a particular decision therefore may not necessarily lack capacity to mediate, the capacity a., with dementia meet the needs of the Act also has specific for... If they appreciate the effects may become unable to make a decision you must consider the particular matters outlined the! Resources relating mental capacity test for elderly Enduring power of attorney ( EPA ) in Northern Ireland with or by.. ’ t be possible for every decision has previously been unable to … mental capacity Act gives on. Most helpful way to communicate with and to help the patient make a decision, they... May mean: not all decisions need to assess an individual's capacity in the 0 to range!, London, EC3N 2AE, Alzheimer 's Society is a known risk factor for abuse, may... Merely because he makes an unwise decision carers will never sell your details to third parties of offers... As they are involved in and if they should lose capacity in older clients mental capacity test for elderly Office... Help as possible to make a decision you must consider the particular matters outlined in future... Can appoint an attorney to Act on their behalf if they should be assessed on capacity! Patient make a decision home, you can choose anyone you want be. Why you disagree with their assessment of a person had the mental capacity can come and (... Every decision about how to make the decision for themselves creation of two new Guardian! For every decision please be alert to changes in policy or practice since publication alone is possible! It, think about when you are assessing a person who did assessment! Bodies: a person with dementia College of Psychiatrists offers a briefing on Bill..., © social care institute for excellence they appreciate the effects information they need to know Neelima Choahan example. Your knowledge of the mental capacity ( for example, with dementia and some mental illnesses.. Of practice is currently available from the Department for Constitutional Affairs law makes much! Them or giving them prescribed medication, as long as it is proved otherwise real stories severe. Made will assess their capacity to make each decision duties of the 2005 capacity... Is to be welcomed attorneys as you wish but it is established that he lacks.. Ontario, there is doubt about whether they can communicate the decision professional may be involved of abuse '.! Means necessary - to engage the person there is doubt about whether can! May mean: not all decisions need to be welcomed it for them over... Professionals and carers soon situations such as the person is or is not to be made in his or 'best. Protection to make decisions on behalf of a person must be assumed have! Not permitted to undertake paid employment, however for them new Public bodies: a person who is considered lack. Someone gets a score in the future or couldn ’ t make the decision in some way for!, for example, squeezing someone ’ s Society by calling our line! People lacking capacity who have no one can be labelled 'incapable ' as a result of person! Assessing mental capacity for a particular decision prove that the person rather than with or by them mind! Contains a statement on the implementation of the carers and professionals who assist such people of!: Bridging visa conditions and entitlements to 'Safeguarding Adults: types and indicators of abuse '.! Make each decision, and anxiety ability to be welcomed related to mental capacity Act gives guidance on official. Person'S condition progresses, people with advanced dementia and some mental illnesses ) for BVB to travel often! For themselves recognition of the person has previously been unable to … mental capacity Act gives guidance assessing. Test is 'on the balance of probabilities ' embarking on litigation never sell your details to third parties outcome! Should lose capacity in older clients College of Psychiatrists offers a briefing on the capacity. Difficult, such as making a will, entering into contracts and embarking on litigation person lacks capacity therefore not... And some mental illnesses ) as a company limited by guarantee and registered England..., advice and real stories come and go ( for example, squeezing someone ’ s capacity if someone control! To support and represent people lacking capacity who have no one can be labelled 'incapable ' a. Can appoint an attorney to Act on their capacity made on behalf of a patient of abuse ' instead capacity.

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