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Journal of Intellectual Disability Research

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Original Article

Financial decision-making capacityW. M. I. Suto

et al.

Correspondence: Dr I. C. H. Clare, Section of Developmental Psychiatry, University of Cambridge, Douglas House,

b Trumpington Road, Cambridge, CB

AH, UK (e-mail: [email protected]).

Capacity to make financial decisions among people with mild intellectual disabilities

W. M. I. Suto,

1

I. C. H. Clare,

1

A. J. Holland

1

& P. C. Watson

2

1

Department of Psychiatry (Section of Developmental Psychiatry), University of Cambridge

2

MRC Cognition and Brain Sciences Unit, Cambridge, UK

Abstract

Background

Although there has been growing rec-ognition of the importance of enabling people with intellectual disabilities (ID) to be more directly involved in managing their own financial affairs, so far, little is known about this aspect of their decision- making.

Method

Using vignettes and semi-structured inter-views, the financial decision-making abilities of men and women with mild ID (

n

=

; mean FSIQ =

.

; SD =

.

) were compared with those of their counterparts in the ‘general population’ (

n

=

; mean FSIQ =

.

; SD =

.

) and ‘very able’ individuals (

n

=

; mean FSIQ =

.

; SD =

.

).

Results

Whilst the financial decision-making abili-ties of participants with ID were generally weaker than those of other participants, the differences were not discrete, and many individuals were judged to be able to make at least some personal financial deci-sions. For all three groups, understanding informa-tion relevant to the decision, and reasoning with it, were the hardest parts of the process.

Conclusions

The findings support a functional approach to the assessment of financial decision-making for both legal and clinical purposes, but raise concerns about mental incapacity legislation and assessment.

Keywords

capacity, choice, decision-making, financial affairs

Introduction

In many jurisdictions, social policies involving dein-stitutionalization (National Health Service and Com-munity Care Act

; United Nations

; Mansell & Ericsson

; Department of Health

) have resulted in increasing opportunities for adults with intellectual disabilities (ID) to be directly involved in making decisions, including decisions about manag-ing their own financial affairs, affecting their own lives (Emerson

et al.

). At the same time, how-ever, enhanced decision-making opportunities have been associated with increased vulnerability to exploitation and abuse (Hickson & Khemka

; Khemka & Hickson

). Inevitably, there is a ten-sion between respect for autonomy, on the one hand, and protection from exploitation, on the other. From a legal, ethical, and clinical, perspective, valid and reliable assessments to identify the extent of an indi-vidual’s capacity to make decisions, the nature of any


W. M. I. Suto

et al

. •

Financial decision-making capacity200

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difficulties, and ways in which it may be possible to maximize decision-making, are central to managing this tension (Wong

et al.

).In England and Wales, as in Scotland [Adults with

Incapacity (Scotland) Act

] and many other jurisdictions, there is a legal presumption that adults have the capacity to engage in meaningful decision-making (British Medical Association & The Law Society

,

). However, this presumption may be called into question, particularly when an individual has the impairments of cognition and affect that characterize, or are associated with, a ‘mental disability’, such as ID, severe ‘mental illness’ or dementia (Law Commission

; Lord Chancel-lor’s Department

,

; Department for Con-stitutional Affairs

,

). Arrangements for proxy decision-making, based on substitute decision-making or ‘best interests’, may then need to be implemented. In England and Wales, formal arrangements for substitute decision-making for men and women who are do not have the capacity to manage their financial affairs are provided through the Court of Protection (Mental Health Act

; Public Trustee and Administration of Funds Act

; Court of Protection Rules

).Given that the Court of Appeal has recently

reiterated the importance of the presumption that individuals are able to make financial decisions for themselves (

Masterman-Lister vs. Brutton & Co. & Jewell & Home Counties Dairies

[

] P.I.Q.R.

), it would be expected that the assessments on which judgements are made, which may lead to the loss of an individual’s right to autonomous decision-making in this area, would be of a very high standard. Unfor-tunately, in a study of the Court of Protection (Suto

et al.

), we found this was not the case. Instead, most assessors relied on the ‘status’ or ‘diagnostic’ approach, which makes assumptions on the basis of an individual’s membership of a specific group (see Wong

et al.

, for discussion). Strikingly, there was little evidence of the use of a ‘functional’ approach, which entails assessing the match between an individual’s decision-making abilities and the demands of a specific decision (Grisso

), although this approach has received the most informed empirical, clinical and legal support (see review by Wong

et al.

), including that of the Government in its proposals for legislative reform (Department for Constitutional Affairs

,

).

Whilst the empirical literature on the use of a functional approach to assist in judgements about the decision-making capacity of people with a ‘mental disability’ is now fairly substantial (Murphy & Clare

), only a few studies have involved people with ID (e.g. Morris

et al.

; Arscott

et al.

; Cea & Fisher

), and none has examined financial decision-making. Instead, most research has focussed on health care decisions among adults with ‘mental illness’ (e.g. Grisso & Appelbaum

,

a,b,

; Appelbaum & Grisso

,

; Grisso

et al.

; Moser

et al.

; Bellhouse

et al.

a,b) or dementia (e.g. Fitten

et al.

; Marson

et al.

; Fazel

et al.

; Wong

et al.

), comparing their decision-making with that of their counterparts in the gen-eral population. The literature suggests that there is a broad relationship between tested intellectual abil-ity and the capacity to make decisions (although no studies have focussed on individuals who are partic-ularly intellectually able), and that the decision-making of people with a ‘mental disability’ is more likely to be impaired. However, such impairment is no means inevitable (Gunn

et al.

): often, there is an overlap between their performance and that of their ‘general population’ peers. Some studies of decision-making have involved ‘real life’ decisions (Grisso

et al.

; Arscott

et al.

; Wong

et al.

), but the majority have used vignettes to present hypothetical decisions (Fitten

et al.

; Morris

et al.

; Marson

et al.

, ; Arscott et al. ; Fazel et al. ; Moser et al. ; Cea & Fisher ). Normally, interviews are then used that are structured to enable judgments to be made about the individual’s capacity to make the particular decision.

Although not uncontentious (see, for example, Bursztajn et al. ), and with slightly different emphases in the USA. (Grisso & Appelbaum ) and the UK [Adults with Incapacity (Scotland) Act ; Department for Constitutional Affairs ,

], there is an emerging consensus that the pro-cess of decision-making requires several key abili-ties: understanding relevant information; using the information to reach a decision, which may involve () appreciating its personal significance and () reasoning with it; and communicating a choice (see Wong et al. , for discussion). Studies involving participants with ID (Morris et al. ; Arscott


W. M. I. Suto et al. • Financial decision-making capacity201

© Blackwell Publishing Ltd, Journal of Intellectual Disability Research , –

et al. , ; Wong et al. ) suggest that, like their peers with a serious ‘mental illness’, they find that understanding relevant information and using it to reason with are the most difficult parts of this process (Grisso et al. ; Moser et al. ). Arguably, though, a further ability needs to be considered: that of identifying that a decision needs to be made, because, in everyday life, indi-viduals may not make decisions simply because they are unaware that the opportunity to do so exists (Jenkinson & Nelms ).

The small study presented here forms part of a larger empirical project investigating financial decision-making among adults with ID (Suto ), which was carried out in the context, initially, of the Law Commission’s proposals for changes to the legislative framework relating to decision-making in England and Wales, and, subsequently, the pro-posed new legislation (Law Commission ; Lord Chancellor’s Department , ; Department for Constitutional Affairs , ). The primary aims of the study were to examine the financial decision-making of adults with mild ID, and to compare their abilities with those of men and women in the ‘general population’ and, because some professional assessors may inadvertently use their own personal abilities as comparators, their ‘very able’ counterparts. It was expected that decision-making would be more difficult for the ‘ID’ group, and moreover, that, because financial decisions vary in their complexity, the performances of all but the most able individuals in the study would deteriorate as the decision-making tasks became more taxing. A further aim was to identify which aspects of financial decision-making were hardest, in order to suggest ways in which capacity might be improved. It was expected that, whilst all the abilities would be weaker among people with ID than among the comparison groups, for all three groups, understanding relevant information and reasoning with it to reach a choice, would be the hardest aspects of the decision-making process.

Method

Ethical considerations

Approval for the study was obtained from the Local Research Ethics Committee. It was anticipated that

some potential participants with ID would have dif-ficulties in giving or withholding consent (Arscott et al. ), although they might be able to assent. However, because these are the very individuals whose capacity to make financial decisions is most likely to be challenged, it was decided that they should not necessarily be excluded from the study. This decision was consistent with current approaches to research involving people who are unable to consent to participation (Medical Research Council ; Law Commission ; Gunn et al. ).

Consent was sought from every potential partici-pant using a simple written information sheet, which was read out and supplemented by a verbal explana-tion. When a potential participant’s capacity to con-sent was uncertain, assent was sought from both the individual and his or her main carer. Great care was always taken to ensure that all the participants were assenting fully and were aware that they could with-draw from the study at any time.

Participants

Sixty paid volunteers participated in the study: were included in an ‘ID’ group; comprised a ‘gen-eral population’ group; and comprised a ‘very able’ group. Participants were selected on a number of criteria: all were aged –, had the expressive language ability to answer simply phrased questions, were native English speakers, and did not have dementia or an active ‘mental illness’. Participants in the ‘ID’ group were recruited through the local ser-vice providing specialist health and/or social care for people with mild ID. Participants in the ‘general pop-ulation’ and ‘very able’ groups were recruited from the local community by advertising in several public locations. The grouping of participants was by a brief assessment of intellectual ability (FSIQ) using the Wechsler Abbreviated Scale of Intelligence (WASI, The Psychological Corporation ). The median FSIQ of participants with no learning disabilities was ; participants with an FSIQ below this were placed in the ‘general population’ group, and participants with an FSIQ of or above were placed in the ‘very able’ group. Recruitment was targeted to ensure that the three groups, whose characteristics are summa-rized in Table , did not differ in age (F2,57 = ., P > .) or gender (c2 = ., d.f. = , P > .).




Measure for assessing financial decision-making abilities

Because there was no suitable existing measure, we drew primarily on the methodologies used for func-tional assessments of other kinds of decision-making (Grisso & Appelbaum ; Fazel et al. ; Wong et al. ; Bellhouse et al. a,b) to develop a measure that could be used to assist in making judge-ments about individuals’ financial decision-making abilities. This involved an iterative process of piloting, involving adults, some of whom had mild ID, who were known socially and recruited informally, and who were not participants in the main study. The measure consisted of five vignettes (see Appendix ) of increasing complexity, illustrated with photo-graphs; each vignette portrayed a decision-making situation and was followed by a semi-structured inter-view (see Appendix ).

The measure could be scored formally in two ways:

Scores for each of the decisions

For each vignette, a participant’s responses to the questions in the interview were scored , , or for each of five decision-making abilities (see Appendix ), so that the measure yielded a total score out of on each of the five financial decisions: decision = ‘In the supermarket’; decision = ‘Buying jeans’; decision = ‘Going to work’; decision = ‘The noisy car’; and decision = ‘Shares in a power company’. A full score ( out of ) for a particular decision suggests that the presumption that the individual has the capacity to make that decision is not rebuttable.

Scores for each of the decision-making abilities

The measure also yielded a total score out of on each of the five decision-making abilities:

identification of the decision that is to be made (‘Identification’); understanding sufficient information that is relevant to the decision (‘Understanding’); reasoning with that informa-tion to come to a decision (‘Reasoning’); ap-preciation of who is affected by the decision (‘Appreciation’); communication of a chosen outcome (‘Communication’).

In addition, an overall score out of could be obtained by summing together either the scores out of on all five decisions, or the scores out of on all five decision-making abilities.

Procedure

Participants were seen individually, and each one completed an assessment of financial decision-making abilities in a single session. Participants in the ‘ID’ group were assessed in their homes or at day-services. Participants in the ‘general population’ and ‘very able’ groups were assessed in university facilities or community centres. All assessment interviews were audiotape-recorded, and subse-quently, were transcribed. The assessments were then all scored by the first author (W.M.I.S.). Twenty per cent were then scored independently by a second rater (A.J.H.).

Statistical analysis

Interrater reliability between the two scorers was assessed using a stringent measure of pair-wise agreement (Kappa, Cohen ). Subsequently, the data were analysed using SPSS Version . for Windows () statistical software. Because the data were, mostly, not normally distributed, non-parametric tests were used (Siegel & Castellan ).

Table 1 Characteristics of the three groups of participants

Group Intellectual disabilities General population Very able

n 30 16 14Mean age in years (SD) 34.80 (9.66) 32.56 (8.39) 37.00 (12.76)% Male 60.00 43.75 42.86Mean FSIQ (SD) 61.80 (10.59) 101.56 (7.62) 123.93 (7.60)




Results

Interrater reliability

Interrater reliability was found to be satisfactory. For four of the abilities (Identification, Understanding, Reasoning, and Communication), agreement on scoring was ‘almost perfect’ (Landis & Koch : k = ., ., ., ., respectively); for the fifth ability (Appreciation), agreement was ‘substantial’ (k = .).

Financial decision-making among people with intellectual disabilities, and a comparison with their ‘general population’ and ‘very able’ peers

Figure shows the mean scores of the three groups for each of the five decisions.

For the first three decisions, the mean scores of the ‘ID’ group were quite high and approximately equal. However, performance decreased markedly on the fourth decision and yet further on the fifth. For each decision, scores within the group varied widely (SD = ., ., ., ., ., for decisions –, respectively).

As anticipated, the scores of participants with ‘ID’ were significantly lower than those of both the ‘gen-eral population’ group (Mann–Whitney: Z = ., P < .; Z = ., P < .; Z = ., P < .; Z = ., P < .; Z = ., P < .; for deci-sions –, respectively) and, unsurprisingly, their ‘very able’ peers (Z = ., P < .; Z = ., P < .; Z = ., P < .; Z = ., P < .; Z = ., P < .; for decisions –, respectively). As Fig. indicates, there was a trend of increasing differences between the scores of the latter two groups, and the ‘ID’ group, as the difficulty of the decisions increased. However, the performance of the ‘general population’ participants was significantly weaker than that of their ‘very able’ counterparts on only the most complex decision, decision (Z = ., P < .), suggesting that performance may have approached ceiling level for many participants in these groups on the earlier decisions.

Figure shows the proportion of participants in each group who obtained full scores ( out of ) on at least one decision, and on all five decisions. Strikingly, in both the comparison groups, as well as in the ‘ID’ group, there were participants who did not

Figure 1 Graph showing the mean scores out of (± standarderror) of the three groups of participants on each decision in theassessment of decision-making abilities.

0

1

2

3

4

5

6

7

8

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10

1 2 3 4 5

Decision

Mea

n s

core

intellectual disabilities

general population

very able

Figure 2 Graph showing the proportion of participants in each ofthe three groups with full scores ( out of ) on (i) at least onedecision (ii) all five decisions, in the assessment of decision-makingabilities.

0

10

20

30

40

50

60

70

80

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100

At least one decision All five decisions

% P

arti

cip

ants


general population

very able




obtain a full score on every decision. Just over a third (.%) of the ‘very able’ group and fewer than a fifth (.%) of the ‘general population’ group obtained full scores on all five decisions.

As expected, the proportions of participants in the ‘ID’ group who obtained full scores on at least one, or all five, decisions, were significantly lower than in either the ‘general population’ (at least one decision: c2 = ., d.f. = , P < .; all five decisions: c2 = ., d.f. = , P < .) or the ‘very able’ (at least one decision: c2 = ., d.f. = , P < .; all five decisions: c2 = ., d.f. = , P < .) groups. However, there were no significant differences between the two comparison groups (assuming P £ .). These findings suggest that, although tested intellectual ability and financial decision-mak-ing abilities are broadly related, the relationship is not straightforward. Indeed, it should be noted that there were individuals in the ‘ID’ group who, on some decisions, obtained higher scores than some of their peers in both the comparison groups.

Patterns of decision-making abilities

Figure shows the pattern of mean scores across the five decision-making abilities.

As expected, the pattern of scores indicated that Understanding and Reasoning were the most difficult parts of the decision-making process both for the participants with ID, and for the two comparison groups.

Unsurprisingly, the ‘ID’ group scored significantly lower on all five abilities than both the ‘general population’ group [Identification: (Mann–Whitney) Z = ., P < .; Understanding: Z = ., P < .; Reasoning: Z = ., P < .; Appreci-ation: Z = ., P < .; Communication: Z = ., P < .] and the ‘very able’ group (Identification: Z = ., P < .; Understanding: Z = ., P < .; Reasoning: Z = ., P < .; Apprecia-tion: Z = ., P < .; Communication: Z = ., P < .). The scores of the ‘general population’ and the ‘very able’ groups did not, however, differ signif-icantly (assuming P £ . throughout), again sug-gesting that the relationship between intellectual ability and decision-making is not straightforward. In support of this suggestion, on all five abilities, there were overlaps between the actual scores of the three groups.

Discussion

The aims of this study were to: () examine the finan-cial decision-making of adults with mild ID; () compare their abilities with those of their ‘general population’ and ‘very able’ peers; and () identify the hardest aspects of the decision-making process. The results largely supported our predictions, but in addi-tion, included some unexpected findings.

Unsurprisingly, adults with ID were found, in gen-eral, to have weaker decision-making abilities than their ‘general population’ and ‘very able’ counter-parts, and most performances deteriorated as the tasks became more taxing. However, individual scores varied widely, and close to half the participants with ID obtained full scores on, and therefore, would be likely to be judged by some legal standards (e.g. Department for Constitutional Affairs , ) to be capable of making at least one decision. Most strikingly, some individuals in this group even scored

Figure 3 Graph showing the mean scores out of (± standarderror) of the three groups of participants on each decision-makingability in the assessment of decision-making abilities.

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Un

de

rsta

nd

ing

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aso

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Ap

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Decision-making ability

Me

an

sc

ore


general population

very able




more highly on some decisions than did several indi-viduals in both comparison groups. The pattern of the ‘ID’ group’s scores on the five decision-making abilities was similar to those of the other two groups: understanding relevant information and reasoning with it were the hardest parts of the decision-making process for most adults, whereas identifying the deci-sion to be made, appreciating who is affected by the decision, and communicating a chosen outcome, were generally easier. When taken together, these findings suggest that the financial decision-making processes of adults with ID are not of a qualitatively different nature to those of the other adults, and decision-making abilities exist along continua that span the three groups. Such abilities relate broadly to tested intellectual ability, but as there is no perfect correlation, other factors must also be involved.

A difference in the abilities of adults in the general population and ‘very able’ adults was apparent only on the hardest decision, and many adults in both these groups appeared to perform near ceiling level. However, the proportions of these groups obtaining full scores on all five decisions were surprisingly low: fewer than a fifth of participants in the ‘general pop-ulation’ group, and just over a third of the ‘very able’ group.

There were several main methodological limita-tions to the study. Because there was no suitable existing measure of financial decision-making abili-ties, the study relied on the use of novel methodology, which has not been validated; similarly, test-retest reliability has yet to be established. The measure involved only hypothetical decision-making situa-tions, and, as is the case with any psychological mea-sure, validity was compromised by the need for it to be practical and acceptable to participants. This mea-sure, which was designed to give an approximate overall picture of an individual’s financial decision-making abilities, involved just five decisions and was thereby very limited in its scope. It addressed only cognitive abilities, and no consideration was given to the social and emotional stressors that may impair their use in everyday life. Furthermore, the study involved only small numbers of participants, partic-ularly in the ‘general population’ and ‘very able’ groups.

Nevertheless, the study’s findings have some important implications. First, the wide variation of participants’ scores emphasizes the individual and

decision-specific nature of decision-making abilities, and therefore, the importance of using a functional approach to establish whether an individual’s abilities meet the demands of his or her personal decision-making situation. Both individuals with ID, and their peers, including some professionals and other ‘very able’ people, may have the capacity to make some financial decisions but not others. Such variation also provides clear empirical grounds upon which to reject the status approach to assessment, which is, at present, the most commonly used approach in formal assessments (Suto et al. ), despite already having been rejected empirically and legally (see Wong et al. ) as well as in case law (e.g. Re C [) All ER ).

Secondly, the findings raise concerns about current and proposed legislation in England and Wales relat-ing to mental capacity (Law Commission ; Department for Constitutional Affairs ) and also Scottish legislation (Adults with Incapacity (Scot-land) Act ). Although adults with mild ID may be less likely to be judged to have the capacity to manage their own financial affairs than adults with no ID, it appears that their processes of financial decision-making are not idiosyncratic, and that con-tinua of decision-making abilities exist across the whole adult population. Current and proposed legis-lation (ibid.), however, includes a presumption of capacity that may be challenged only when an indi-vidual has a ‘mental disability’ or is unable to com-municate sufficiently. It assumes implicitly, therefore, the existence of a qualitative psychological distinction between the decision-making abilities of people with and without a ‘mental disability’. Arguably, this is potentially discriminatory, and forces a partial use of the status approach to capacity assessment.

A further concern, highlighted by the variation among all adults in the study, is the level of decision-difficulty at which the threshold for having legal capacity should be set. Few individuals in the com-parison groups obtained full scores on all the deci-sions, and as, legally, the capacity of adults with no ‘mental disability’ is largely irrefutable (excepting those who are unable to communicate sufficiently), capacity in the general population may be over-estimated. Moreover, as the professionals making formal assessments and legal judgements of capacity are likely to be ‘very able’ and, therefore, to have decision-making abilities that are generally strong,




some may lack personal experience of problems in decision-making. They may not realize, therefore, that many people in the general population have the same difficulties in making hard financial decisions as the individuals whose capacity the assessors are considering. If this is so, then many adults with mild ID whose decision-making abilities are no poorer than those of most people, may formally be deemed to lack capacity.

The finding that understanding relevant informa-tion, and reasoning with it, are generally the hardest parts of decision-making is consistent with the find-ings of studies other decision-making, involving adults with ID (Morris et al. ; Arscott et al. , ; Wong et al. ), and also adults with ‘mental illness’ (Grisso et al. ; Moser et al. ). It has important implications for the directions of future research, including the development of ways to improve decision-making abilities. Further studies may focus specifically on understanding and reason-ing, considering in more depth the cognitive pro-cesses involved in these abilities, and the nature of the information that must be understood in order to make financial and other decisions.

There is also a need to identify factors affecting these particular abilities. As mentioned previously, the relationship between tested intellectual ability and decision-making abilities is not a perfect cor-relation. Other factors that potentially may affect decision-making abilities include an individual’s opportunities for, and past experiences of, decision-making, as well as social and emotional influences. If such factors can be identified, then ways of enhancing them, and thereby improving decision-making abili-ties may be developed. In turn, such improvements in financial decision-making may lead to greater autonomy for adults with ID.

Acknowledgements

The study reported in this paper was carried out by Dr Irenka Suto as part of a project on the manage-ment of financial affairs by people with a ‘mental disability’ that was funded initially by a Postgraduate Scholarship from the Nightingale Trust of Trinity Hall, Cambridge. Further development of the project was funded, first, by the Nuffield Foundation and then by the Health Foundation. We are grateful to the

Nightingale Trust, the Nuffield Foundation, and the Health Foundation for their generous support. We would also like to thank all the men and women who participated and without whose support the study would not have been possible.

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Accepted March

Appendix 1: Vignettes in the measure of financial decision-making abilities

1. In the supermarket

This is John. John needs to buy some milk for making tea and coffee. Milk costs p. John has p, and goes to the supermarket to buy some milk. When he gets to the supermarket, John sees the chocolate sec-tion. John really likes chocolate bars. He feels like buying a chocolate bar to eat now. A chocolate bar costs p. John has p. Milk costs p, but a chocolate bar costs p too. John now has to make a choice.

2. Buying jeans

This is John. John has £ to spend on some new jeans. John goes shopping. He sees some jeans, which he quite likes. These jeans cost £. Then John sees some different jeans, which he likes even more. These jeans cost £. John now has to make a choice.

3. Going to work

This is John. John has a job. He is a gardener at a school near his house. John earns £ an hour. He works from am until pm, from Monday to Friday. John is supposed to go to work today, but he doesn’t

feel like going, because it is raining. John now has to make a choice.

4. The noisy car

This is John. John has a car, and it is making strange noises. He doesn’t know much about how cars work, so he takes it to the garage. The mechanic at the garage tells John that the car is quite old and has several big problems. He says it will cost £ to repair the car, but the car will probably only last for another year anyway. The mechanic offers to buy the car for £, even though he says it is only worth £. Last week, John’s sister told him she thought the car was worth at least £. John now has to make a choice.

5. Shares in a power company

This is John. Ten months ago, John bought shares in a power company, at p per share. Since then the price of these shares has dropped slightly, but is now rising. The FTSE , however, has been quite variable over the past months. In months’ time, John will need to use the money that he has invested in the power company to make a purchase of at least £ . Today John reads some advice in the Financial Times newspaper about buying and selling these shares. The Financial Times says:

Only a select few companies in this category have avoided having their shares crushed in the cur-rent bear market in the past days and so far, investors have been lucky. Although profits in the past year have been reasonable, the general stag-nation in demand for enriched uranium, and its rising global production, may indicate a change in fortunes. Plants, however, have not increased in efficiency, and are now operating far from capacity. In a move that would have been incon-ceivable only a few years ago, some utilities are again considering the construction of new reac-tors. In spite of this, the possibility of a take-over is still not imminent; acquisition restrictions imposed at the time of privatisation will not expire for two years.

John now has to make a choice.




Appendix 2: Framework of questions used for semi-structured interviews, and scoring system, in the assessment of financial decision-making abilities

Decision-makingability Questions

Scoring system

Score Scoring criteria

Identification Can you tell me what choice must be made here?(Who has to make a choice? What choice does John have to make?)

0 No relevant information offered.1 Aware that a choice must be

made, but cannot identify what that choice is; or identification of only one of the options that the choice entails.

2 Correct identification of the choice that must be made.

Understanding What could John choose to do? 0 No relevant information offered.Is there anything else that he could choose to do?What are the advantages of doing x?(What would be good about doing x?)And the problems?

12

Partial identification of advantages and problems, i.e. less than one of each for each choice outcome.

What are the advantages of doing y?(What would be good about doing y?)And the problems?

Identification of at least one advantage and one problem for each of 2 or more choice outcomes.

Reasoning What do you think John should do? 0 No relevant information offered.Why do you think he should do this? 1 Opinion on decision outcome

offered, but with an insufficient explanation of why.

2 Opinion on decision outcome offered, with a sufficient explanation of why.

Appreciation Who does this choice affect?Will it affect anyone else?

0 No relevant information offered, or thinks that the choice will affect only people who are actually unaffected.

1 Aware that the choice will affect the character in the vignette, but also thinks the choice will affect people who are actually unaffected.

2 Aware that the choice will affect the character in the vignette (and possibly others)

Communication [No questions relating directly to this ability] 0 Unable to communicate anything1 Ambiguous communication2 Able to communicate a choice