title: Deathbed wills: assessing testamentary capacity in the dying patient.
abstract: BACKGROUND
  Deathbed wills by their nature are susceptible to challenge. Clinicians are frequently invited to give expert opinion about a dying testator's testamentary capacity and/or vulnerability to undue influence either contemporaneously, when the will is made, or retrospectively upon a subsequent challenge, yet there is minimal discourse in this area to assist practice.
  
  
  METHODS
  The IPA Capacity Taskforce explored the issue of deathbed wills to provide clinicians with an approach to the assessment of testamentary capacity at the end of life. A systematic review searching PubMed and Medline using the terms: "deathbed and wills," "deathbed and testamentary capacity," and "dying and testamentary capacity" yielded one English-language paper. A search of the individual terms "testamentary capacity" and "deathbed" yielded one additional relevant paper. A focused selective review was conducted using these papers and related terms such as "delirium and palliative care." We present two cases to illustrate the key issues here.
  
  
  RESULTS
  Dying testators are vulnerable to delirium and other physical and psychological comorbidities. Delirium, highly prevalent amongst terminal patients and manifesting as either a hyperactive or hypoactive state, is commonly missed and poorly documented. Whether the person has testamentary capacity depends on whether they satisfy the Banks v Goodfellow legal criteria and whether they are free from undue influence. Regardless of the clinical diagnosis, the ultimate question is can the testator execute a specific will with due consideration to its complexity and the person's circumstances?
  
  
  CONCLUSIONS
  Dual ethical principles of promoting autonomy of older people with mental disorders whilst protecting them against abuse and exploitation are at stake here. To date, there has been scant discourse in the scientific literature regarding this issue.
authors.affiliation: University of New South Wales, Sydney, Australia; University of Sydney, Sydney, Australia; Australian Centre for Capacity (ACCEPD), Australia.
authors.forename: C
authors.initials: C
authors.lastname: Peisah
authors.affiliation: On Lok Lifeways, San Francisco, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Luxenberg
authors.affiliation: Department of Psychiatry, Baystate Medical Center, Springfield, Massachusetts, Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: B
authors.initials: B
authors.lastname: Liptzin
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia; South Eastern Sydney Local Health District, Sydney, Australia.
authors.forename: A P
authors.initials: AP
authors.lastname: Wand
authors.affiliation: Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Shulman
authors.affiliation: University of Chicago Medical School, Wilmette, Illinois, USA.
authors.forename: S
authors.initials: S
authors.lastname: Finkel
mesh_terms: D003693:Delirium / Q000209:etiology / Q000523:psychology*; D026690:Ethics, Clinical; D005104:Expert Testimony / Q000941:ethics / Q000331:legislation & jurisprudence; D006801:Humans; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D019452:Terminally Ill / Q000331:legislation & jurisprudence / Q000523:psychology; D014918:Wills / Q000331:legislation & jurisprudence / Q000523:psychology