The assessment of clinical competency to consent to medical rehabilitative interventions

A model for evaluating traumatically brain-injured adults' competency to consent to rehabilitative interventions is presented. Assessment foci are capacity to understand and reason. It is argued that judgments regarding competency should be based on best observed performance under optimal conditions in a rehabilitative context that promotes patient self-sufficiency. The proposed methodology provides a practical means of assessing competency in persons with traumatic brain injury (TBI) whose functional abilities can be quite variable, and of evaluating the effect of structuring patient-provider interactions so as to maximize the patient's capacity to understand and to reason.