MAID - Automatic Third Capacity Assessment Adds Nothing

In the United States, patients must have decision making capacity to request medical aid in dying (MAID). That is generally assessed by both an attending and a consulting clinician. If either is unsure, then they must refer to a mental health specialist. 

But there have been two notable exceptions to this general approach. In Hawaii and UCSF a third capacity assessment has been automatically required. But now data from both indicates this automatic third assessment adds no value. Accordingly, UCSF dropped the requirement. Hawaii still requires it.

The UCSF researchers found: "Mandatory mental health assessments for all patients requesting MAID at a single academic medical center did not identify patients who lacked decisional capacity to pursue MAID, and potentially created access barriers to seriously ill patients seeking this intervention."

The Hawaii researchers found: "Terminally ill patients should not, however, be required to undergo a potentially costly, time consuming, and burdensome evaluation by a mental health specialist unless the attending or consulting provider finds that there is a clear reason to do so."