I have not done any capacity assessments for MAID, but I do capacity assessments for finances, personal decision-making and medical decision-making all the time. A lot of my patients are frail and are living with issues of potential financial abuse, as well as maybe making decisions that their family doesn't agree with. For instance, they may want to stay at home despite the fact that they're falling or they may not be eating as well. They really are able to come to a decision and say that this is where they want to be. Their decisions need to be honoured.
They obviously have short-term memory, so when you're trying to give them the pros and cons, they often have difficulty holding the information in their brain long enough to come to a decision. They have some impairment in judgment and insight, especially if the frontal parts of their brain are affected.
They occasionally have emotional lability. For instance, with a toddler, their frontal brain is not yet mature and there are these swings of emotions where in one moment they're in the depths of despair and in a minute they're laughing and happy. It can switch quite quickly. Some elderly people, especially with fronto-temporal dementia or people who have strokes in the frontal part of their brain, will have this as a problem. They're also easily fatigued, so a lot of times they cannot have an assessment in one go and you need to have multiple assessments.
Finally, they are often completely dependent on their caregiver. If someone is living with them, they're dependent on the caregiver not only for hands-on care, but also for decision-making to help them in life. This leaves them open to the possibility of undue influence. Because they have someone they are potentially insulting or going to make upset by going against their wishes, they may feel obliged to agree with them.
That's what I see a lot of times in people who tell me they want to live in their own home. They are capable, but because they don't want to make waves and they want to keep their family happy, they end up deciding to move into care. It's legal. They made the decision and they were capable at the time, but it is still very heartbreaking because that is not how they wanted to spend the end of their life.