Box 2.

—Guidelines for competence question and answer sheet

Question 4

Valid reasons show that the individual is able to discriminate between the intervention and non-intervention choices. Therefore answers like “to live,” “in order to keep me alive,” or “I do not want to be a burden to others” are acceptable. Responses such as “I do not like hospitals, needles, or operations” are not.

Question 6

Valid answers indicate that the individual is able to imagine significant consequences of the decision they make. Answers that the family will “go along with my decision,” “back me up,” or “accept my choice,” or that family members will be upset, anxious, or relieved do not show that they have considered how their treatment decision will affect their families’ lives. Further clarification is needed. If interviewed individuals do not have family, then the question can be rephrased to ask what the decision would mean for a close friend.

Question 7

If no answer is given initially, the question can be rephrased to ask what effect the treatment will have after 1 or 2 weeks. For those that choose medical interventions, answers must show an awareness of recovery in hospital.

Question 8

Answers must show discrimination between intervention and non-intervention choices. If no response is given initially, the question can be rephrased to ask what effect the treatment decision will have after a few months.