Mr. Franks refuses surgery - Cognition and values in competency determination in complex cases

The evaluation of medical decision-making competency is challenging and sub ject to low reliability for many reasons including potentially difference l ife perspectives and cognitive processes between evaluators and patients, b ut especially because of the difficulties in defining and determining "comp etency" in complex cases. In this article, the case of an elderly man who i s refusing surgery is presented to illustrate such difficulties. In these s ituations, the evaluator can assess both specific decisional tasks and pers onal values relevant to health care. Instruments designed to assess such sp ecific decision-making abilities and values have benefits and limitations.