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Competence to Terminate Life-Sustaining Care

Ethical and Legal Considerations

Department of Psychiatry and Biobehavioral Sciences, School of Medicine, University of California at Los Angeles and the Psychiatry Service, West Los Angeles Veterans Affairs Medical Centre, Los Angeles,CA; and the Department of Psychiatry at the University of Texas Health Science Center at San Antonio and the Psychiatry Service, Audie L. Murphy Memorial Veterans Hospital, San Antonio, TX.

Recent federal legislation requires that patients be provided with information about advance directives for terminating health care. Although the mental status of patients executing these directives is crucial, and states require competence to make such a directive, no clear criteria or mandated procedures exist to evaluate the patient's competence to make these decisions. No explicit criteria exist for competence of surrogates either. The authors propose guidelines for such competence determinations. They also consider psychiatric factors surrounding decisions to terminate life-sustaining care. Such decisions have particular importance for geriatric patients. Further research is needed to guide both physicians and policymakers in determining the frequency and types of psychiatric problems in such patients and resultant "irrational" decisions to die.