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Tijdschrift voor Psychiatrie 61 (2019) 11, 766 - 772

Review article

Decision-making competence in patients with an intellectual disability

I.M. Hein, J. Raymaekers, E. Kres, B.J.M. Frederiks

background Mental competence is a complex concept within the contexts of ethics, law, psychology and medicine. Competency is a prerequisite for giving informed consent for a medical intervention. It has long been wrongly thought that people with intellectual disabilities as a group are incapacitated, but competence is not a categorical trait of a certain group of persons. Capacities can fluctuate over time and can vary per decision or action domain. The more severe the intellectual disability, the less likely that someone is competent in health care decision-making.
aim To describe specifically the meaning of the concept of competence in people with intellectual disabilities and the legal frameworks in the Netherlands and Belgium. Furthermore, to provide practices for assessing competence and to focus on supporting competence in this target group.
method Overview of the most recent theory and practical methods.
results The assessment of decision-making competence can be difficult and has far-reaching consequences, and must therefore be applied carefully and well-founded.
conclusion It is advisable to support people with an intellectual disability in order to be able to make decisions themselves as much as possible.

keywords decision-making competence, intellectual disability, mental competence