Civil forensic psychiatry — testamentary capacity and disability IME (MEQ)

(i) Testamentary capacity (Scenario A). Capacity is decision- and time-specific, not a dementia label. Map to Banks v Goodfellow teaching principles: nature/effect of a will; nature/extent of property in broad terms; appreciation of claims of those who might expect to benefit; absence of disorder that poisons the disposition. If assessed while alive and contemporaneous, interview with teach-back and collateral. If the person has died, use retrospective reconstruction: contemporaneous medical notes, solicitor observations, draft wills, timeline of cognition — avoid false certainty when records are thin. Undue influence is a separate analysis (susceptibility, opportunity, unnatural transaction) and can coexist with capacity or incapacity; a new carer beneficiary and exclusion of children are risk markers, not automatic proof of either theory. Do not invent succession-act section numbers.[2][3][4]

(ii) Delirium and deathbed wills. Drowsiness and near-death timing raise delirium and fluctuation. Document alertness, orientation, attention, and whether a lucid interval genuinely existed at signing. If still alive and fluctuating, treat reversible causes and reassess rather than opining from a single cloudy snapshot.[5][2]

(iii) Disability/IME structure (Scenario B). Clarify insurer referral questions. Disclose retaining party, forensic (usually non-therapeutic) role, and confidentiality limits. Review records (ED, GP, psychology, employment). Structured history of trauma, symptoms, prior psychiatric illness, treatment, function. Full MSE. Diagnosis using recognised criteria. Functional analysis of work and ADLs. Explicit answers to each question. AAPL disability guidance is the structure scaffold.[6][7][9]

(iv) Causation, impairment/disability/fitness, validity. Reason about relationship of the collision to the psychiatric presentation (new disorder, aggravation, or coincidental), using jurisdiction-appropriate caution without inventing tort formulae. Separate impairment (clinical findings), disability (role limitation), and fitness for a specific job (match to job demands). Consider symptom/performance validity when self-report drives the claim; integrate patterns rather than single cut-score justice.[6][7][8]

(v) Report essentials and pitfalls. Essentials: questions, sources, role/consent, history, MSE, investigations, formulation, opinions mapped to criteria, limitations. Pitfalls: diagnosis = incapacity/disability; dual-role confusion; invented statutes; ignoring delirium in deathbed wills; ignoring validity in high-stakes disability claims; answering unasked ultimate legal issues beyond role.[1][6][9]