Dr. Jacob Appel

In this episode of Psychiatry Bootcamp, Dr. Mark Mullen welcomes Dr. Jacob Appel, psychiatrist, attorney, bioethicist, polymath, and emergency psychiatrist, for a rigorous and clinically grounded critique of the Applebaum-Grisso "Four Abilities Model" of decisional capacity assessment. Dr. Appel traces the model's origins in the 1980s as a patient-empowerment tool, examines how its statutory adoption across more than half of US states has calcified it beyond its original intent, and describes in detail the categories of patients for whom the model systematically fails.


As an alternative, Dr. Appel describes the values-based model, which asks clinicians to identify a patient's current expressed choice, explore the underlying values that have governed the patient's life, and determine whether the two are congruent. He also introduces the consistent preferences approach, which situates capacity within a person's narrative arc rather than a moment-in-time snapshot.nce intervention pr…