The terms capacity, competency and guardianship are ones all neuropsychologists have heard of, but most probably don't sufficiently understand. This book corrects that, and then some!

Some neuropsychologists seek out legal work, and others have it thrust upon them. Those who plan ahead now have options in graduate school and post-graduate training to learn about personal injury cases, the ethical challenges of doing clinical work, how to serve as an expert witness, or even criminal/forensic work including evaluation and treatment of those in the criminal justice system. In addition, a casual glance at most journal or conference offerings these days allows more than ample opportunities to learn about assessment of effort, response bias, and the assessment of mild traumatic brain injury, all important topics for today's neuropsychologist engaged partially or wholly in medicolegal consultation.

While it has been easy for neuropsychologists to learn about the topics described above, this has not necessarily been the case for the topics covered in Civil Capacities in Clinical Neuropsychology. Casual conversation with colleagues typically will show that most neuropsychologists “sort of” understand the differences between the terms competency and capacity, for instance, but perhaps not well enough for them to voluntarily solicit related cases. In addition, many neuropsychologists have had the experience of a “clinical” case becoming “legal”. This may occur as a result of subsequent filing of a personal injury lawsuit or disability claim or, increasingly, by patients, families, or legal representatives seeking to use recent cognitive assessment findings as a means to take away a patient's independence or autonomy. Examples might include challenging a will, endorsing or rejecting a power of attorney for health care and/or finances, or questioning the patient's ability to drive a motor vehicle. Additionally, it is well documented that the American population is aging, and with advanced age comes increased risk of dementia and increased risk of difficulties in making sound decisions or behaving in ways that advance one's best interests.

This volume will be a welcome addition for readers with various needs or interests. These would include busy clinicians who wish to read a chapter or two to reacquaint themselves with terms, concepts, or tests for the occasional capacity case. Researchers and clinicians who frequently encounter these issues may of course avail themselves of larger portions. As in most edited books, there is some redundancy but not terribly much. Still, if one reads the book straight through one will experience some déjà vu re-reading about lists of recommended tests, citations of legal concepts and scholarly findings, and explanations of terms and definitions.

The book is divided into four sections: Background; Civil Capacities and Guardianship; Applications; and Conclusions. Demakis contributes the introductory and closing chapters. In his opening comments he makes an important distinction in clarifying that “capacity” typically refers to a decision made by a psychologist or another health care provider, whereas “competency” most often refers to a judgment make by a judge about a patient's legal status. Considerable discussion follows in subsequent chapters about where the “line is drawn” as to whose opinion (the clinician or the judge) is the one that ultimately carries the day. Of course, some congruence between opinions is hoped for, and the “ultimate issue” is reviewed in detail in Chapter 12, with some movement in the direction of judges allowing for or asking experts their bottom-line opinion as to whether a patient has a particular capacity/competency. This obviously stresses the importance of report-writers knowing and answering “the question” being asked of them, and knowing what limits or conditions might be placed on their expressed opinions. The authors of this chapter also provide some helpful advice on report-writing and testifying. While several other chapter authors also provide report writing tips, it will be up to each reader to discern whether these sections represent preventable redundancies or instead is something “value added” to each chapter. As this volume might be read by clinicians one or two chapters at a time it does seem useful for the various authors to include their particular perspective on sample reports and offer personal advice.

Ruchinskas’ chapter, “Other Aspects of Data Collection in Capacity Evaluations,” is of particular interest because the nuanced and clear-headed evaluations recommended apply to all clinical neuropsychological evaluations and not only to cases involving competency and guardianship. His citations on biased reporting and poorly-informed decision-making are useful, as are the strategies provided for interviewing and “risk assessment”. Chapters on research strategies and ethical considerations are well written if not unique. Chapters on instruments and methods of addressing the particularities of competency assessment are more specific and will be of use to those who must supplement their relatively standard neuropsychological batteries. These reviews are helpful since many neuropsychologists may not be familiar with capacity-specific instruments.

Nearly half of the book chapters review specifics in assessing particular civil capacities and guardianship, including a chapter on financial capacity by Marson and colleagues. These chapters remind the reader that capacity is specific to particular domains. Chapters on Healthcare Decision Making, Testamentary Capacity, Driving, and Personal Care, and Independence, as well as Guardianship each include a case study and practical tips specific to the respective capacity. Some overlap between chapters might have been avoided in a single-authored volume but each of these chapters is well-written and useful about the specific type of capacity assessment. Some chapters, including that of Testamentary Capacity, have interesting reviews of “retrospective assessment,” a unique and perhaps expanding area of inquiry for neuropsychologists. It is challenging enough to evaluate patients when they are in your office so one can imagine assessing the capacity of someone who has already passed away and whose will or estate instructions are now being challenged or reviewed. An interesting case study of retrospective assessment is presented. Future editions of this book would benefit from expanded discussion on how to conduct retrospective assessments.

In conclusion, Civil Capacities in Clinical Neuropsychology: Research Findings and Practical Applications is an excellent review of how neuropsychologists can be maximally useful to courts, individuals, and their families in assessing capacity in various domains of functioning. It covers a broad range of topics, but all emphasize a practical approach on how to understand and incorporate legal standards, recent research findings, and clinical applications. This volume is unique and will nicely fill a gap in the libraries and knowledge base of many neuropsychologists.