Civil forensic psychiatry — structured clinical viva

Frame. This is civil forensic work: multiple decisions (will; complex investments; possible substitute decision-making). Vascular cognitive impairment raises risk but does not equal global incapacity. Assess each decision against the relevant legal principles for the jurisdiction — name principles, do not invent Act sections.[1][5]

Testamentary. Apply Banks v Goodfellow teaching principles with teach-back on will nature/effect, property in broad terms, natural objects of bounty, and absence of disordered motivation poisoning the gift. Document MSE and collateral.[2][3]

Financial. Domain-map: everyday transactions, bills, assets, gifts, investments, scam vulnerability. Complex portfolio management may fail while simple bill-paying remains — partial capacity is common and important.[3][4]

Guardianship interface. Opine domain-by-domain with residual abilities and less-restrictive supports; avoid a single pejorative “incompetent” stamp. Local pathways for financial management orders are jurisdiction-specific.[5]

Appelbaum–Grisso / MacCAT-T. Understanding, appreciation, reasoning, expressing a choice is the functional scaffold for many civil decisions; MacCAT-T is most validated for treatment decisions as an adjunct, not a court substitute.[6][7]

Dual role. If treating doctor, disclose conflict: therapeutic alliance vs expert neutrality. Prefer independent expert when contested; if unavoidable, state dual role and limits clearly.[8][9]

Report. Questions separated; sources; role; history; MSE; criterion-linked opinions; limitations; no invented statutes.[8][9]

1. Property limb weak; may lack capacity for that will despite understanding will formalities — document specifically.[2]
2. Reconstruct from contemporaneous notes, drafts, witnesses; state uncertainty if records poor.[2][3]
3. Isolation, dependence, sudden change, unnatural beneficiary — separate theory from capacity; both can be discussed.[4][5]
4. Imaging adjunctive; functional interview can still proceed; note limitations and medical differential incompleteness.[8]
5. Fitness for director role = job-specific demands, governance risk, and function — related but not identical to household financial capacity.[1][5]