Dorien Bangma

222 | CHAPTER 9 Can we afford it? FDM capability is a sensitive topic and (clinical) decisions regarding the financial autonomy of an individual can have far-reaching consequences for an individual and his or her environment. In clinical practice, it is therefore crucial to make (clinical) decisions about an individual’s FDM capability in a careful and ethical manner. For this, it is important to find a balance between the four ethical principles that are important to health care: autonomy, beneficence, justice and non-maleficence (Beauchamp & Childress, 2001). In (Dutch) clinical practice, however, little or no standardized and valid assessments are currently being conducted in order to evaluate the financial capability of an individual. We cannot afford this , because wrong clinical decisions can on the one hand have major (financial) consequences for an individual, their environment and society (e.g., when a financially incompetent individual is incorrectly classified as financially competent). On the other hand, wrong clinical decisions can also lead to a wrongful loss of autonomy of the patient (e.g., when a financially competent individual is incorrectly classified as financially incompetent). A careful and comprehensive evaluation of the capability to make financial decisions is therefore utmost important to be able to draw careful clinical decisions and to provide adequate protection and assistance (Appelbaum et al., 2016; Marson, 2016; Wood & Lichtenberg, 2016). In the context of FDM capability, it is important to evaluate several aspects of FDM in order to provide a broad picture of both the financial competence and financial performance of an individual. Furthermore, influential contextual factors should be taken into account in this evaluation. For this, it is important to aggregate different sources of information, including both indirect and direct evaluations, in order to make decisions about an individual’s FDM capability (Appelbaum et al., 2016). The addition of performance-based tests and questionnaires can therefore add to this decision- making process. More research is, however, needed in order to make the current FDM test battery applicable for this purpose. Nevertheless, the studies presented in current thesis provides important steps forwards to afford the use of the FDM test battery in clinical practice over time. To be continued…