Poster Presentation Joint 2016 COSA and ANZBCTG Annual Scientific Meeting

The assessment of testamentary capacity in advanced malignancy (#304)

Gauri Gogna 1 , Pretoria I Bilinski 1
  1. Greenslopes Private Hospital, Greenslopes, QLD, Australia

Introduction: The concept of capacity and the corresponding ability to make independent decisions regarding healthcare and finances is complex, and currently has no clear “gold standard” for assessment. Patients’ mental states and their capacity may change. This can lead to difficulties in managing their care, throughout treatment and particularly towards palliation and end of life. 

Case description: Mr SC was a 75 year old man with epitheliod malignant mesothelioma. This was treated with standard chemotherapy, however after thirteen months of treatment he progressed and became palliative. His treatment was complicated by his wife and enduring power of attorney (EPOA) who refused to allow him to be managed with opioids. When alert and compos mentis he requested opioids for pain and dyspnoea management; however once sedated, his wife would order their cessation. This culminated in the patient being independently assessed by a geriatrician and occupational therapist to determine his capacity. Once found to be of sound mind, he changed his EPOA so as to allow himself to be palliated effectively. 

Discussion: The methods and tools used to assess patients and their capacities  are varied. These range from the mini mental state examination and montreal cognitive assessment to neuropsychological evaluation1,2,3. Currently there is no “gold standard” assessment tool for determining capacity, and the general consensus consists of a multifactorial approach, with both medical and legal evaluations4. In assessing capacity, it is important to bear in mind one should not infer an overall lack of capacity from lack of capacity in a specific area5. Upholding a person’s autonomy and right to make their own healthcare decisions is paramount6. This case highlights the complexities involved with assessment, and the need to focus on patients, their needs and best interests. 


  1. 1. Getz, L. MMSE vs. MoCA; What you should know. Today’s Geriatric Medicine – Web Exclusives. [Internet] 2011 Feb (cited 2015 Oct 10th) Available via:
  2. 2. Nasreddine Z, Phillips N, Bedirian V et al. The Montreal Cognitive Assessment, MoCA: A brief Screening tool for Mild Cognitive Impairment. Journal of the American Geriatrics Society. 2005 Apr Vol53 695-699
  3. 3. Malik A, Kishner S. Neuropsychological Evaluation. Medscape Online. [Internet] 2015 March 11th (cited 2015 Oct 17th) Available via:
  4. 4. Purser, K, Rosenfeld T. Evaluation of Legal capacity by doctors and lawyers; the need for collaborative assessment. Med J Aust. 2014 Oct Vol 201 98 483-485. DOI 10.5694/mja13.11191
  5. 5. O’Connor D. Incapability Assessments: A Review of Assessment and Screening Tools. Final Report. Prepared for the Public Guardian and Trustee of British Columbia. [Internet] British Columbia, Canada. For the University of British Columbia 2009, Apr 20th. (cited 2015 Oct 15th) pgs 5-38 Available via:
  6. 6. Allens Queensland Advocacy Incorporated. Queensland handbook for Practioners in Legal Capacity. Prepared for The Queensland Law Society. [Internet] Brisbane, Australia. 2014 Mar 20th (cited 2015 October 10th) pgs 5-10. Available via: