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Deathbed wills: assessing testamentary capacity in the dying patient

Published online by Cambridge University Press:  05 November 2013

C. Peisah ,
J. Luxenberg ,
B. Liptzin ,
A.P. Wand ,
K. Shulman  and
S. Finkel
C. Peisah*
Affiliation:
University of New South Wales, Sydney, Australia; University of Sydney, Sydney, Australia; Australian Centre for Capacity (ACCEPD), Australia
J. Luxenberg
Affiliation:
On Lok Lifeways, San Francisco, California, USA
B. Liptzin
Affiliation:
Department of Psychiatry, Baystate Medical Center, Springfield, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts
A.P. Wand
Affiliation:
Sydney Medical School, University of Sydney, Sydney, Australia; South Eastern Sydney Local Health District, Sydney, Australia
K. Shulman
Affiliation:
Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
S. Finkel
Affiliation:
University of Chicago Medical School, Wilmette, Illinois, USA
*
Correspondence should be addressed to: Carmelle Peisah, Specialist Mental Health Services for Older People, Mental Health Drug and Alcohol, Northern Sydney Local Health District, 21 Manning Rd, Macquarie Hospital, North Ryde 2113, Australia. Phone: 9887 5451; Fax: 9887 5678. Email: cpeisah@nsccahs.health.nsw.gov.au.
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Abstract

Background:

Deathbed wills by their nature are susceptible to challenge. Clinicians are frequently invited to give expert opinion about a dying testator's testamentary capacity and/or vulnerability to undue influence either contemporaneously, when the will is made, or retrospectively upon a subsequent challenge, yet there is minimal discourse in this area to assist practice.

Methods:

The IPA Capacity Taskforce explored the issue of deathbed wills to provide clinicians with an approach to the assessment of testamentary capacity at the end of life. A systematic review searching PubMed and Medline using the terms: “deathbed and wills,” “deathbed and testamentary capacity,” and “dying and testamentary capacity” yielded one English-language paper. A search of the individual terms “testamentary capacity” and “deathbed” yielded one additional relevant paper. A focused selective review was conducted using these papers and related terms such as “delirium and palliative care.” We present two cases to illustrate the key issues here.

Results:

Dying testators are vulnerable to delirium and other physical and psychological comorbidities. Delirium, highly prevalent amongst terminal patients and manifesting as either a hyperactive or hypoactive state, is commonly missed and poorly documented. Whether the person has testamentary capacity depends on whether they satisfy the Banks v Goodfellow legal criteria and whether they are free from undue influence. Regardless of the clinical diagnosis, the ultimate question is can the testator execute a specific will with due consideration to its complexity and the person's circumstances?

Conclusions:

Dual ethical principles of promoting autonomy of older people with mental disorders whilst protecting them against abuse and exploitation are at stake here. To date, there has been scant discourse in the scientific literature regarding this issue.

Keywords

testamentary capacitydeathbedwills
Type
Review Article
Information
International Psychogeriatrics , Volume 26 , Issue 2 , February 2014 , pp. 209 - 216
Copyright
Copyright © International Psychogeriatric Association 2013 

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