Ethical issues in the evaluation of competence in persons with acquired brain injuries 1

The evaluation of competency in an individual with acquired brain injury has become an area of increasing concern to health care professionals in recent years. The evolving neurobehavioral status, nature and extent of diminished cognition and the post-discharge environment are factors which must be considered when assessing the competency of a person with brain injury to function independently in the community. In addition, clinicians must be familiar with the distinctions between various definitions and models of competency. In most rehabilitation settings, competency to consent to treatment, care for self and property and manage financial affairs are the issues most commonly observed. In the case of acquired brain injury, clinicians are well-advised to maximize a patient's autonomy and avoid a paternalistic stance, whenever possible. Treatment of the patient and family should be directed toward developing compensatory behaviours to allow for safe and successful community reintegration with as much dignity and autonomy as possible.