That's a great question. We also discussed that at our panel at CAMH.
I think it's critical to have a comprehensive capacity assessment for someone who has a mental illness but is suffering from a non-mental illness which could be the grievous and irremediable condition. As you are suggesting, I think it would be critical to evaluate whether the request for PAD, for example, is being driven by the mental illness itself or the view of their physical illness as influenced by the mental illness.
That's something, as psychiatrists, we engage in even now with different types of decisions. For example, when one of my patients has a chronic mental illness and they develop cancer, let's say, the oncologist would consult me to see if the decisions being made around the cancer treatment are influenced by the comorbid mental illness of schizophrenia, and how much the refusal or acceptance of a treatment is influenced by the cognitive distortions or beliefs that are driven by the mental illness.