Abstract
The case of May Redwing, an American Indian woman assessed for competence is examined in detail. The case highlights the interconnections between the cultures of medicine and law and notes the importance of criteria of competence assessment, but also underscores the necessity of attention to the patient'scultural background in a multi-disciplinary competence assessment team process. Three interrelated areas of inquiry are explored: (1) Can we expect a morally and politically justifiable assessment of competence from a multi-disciplinary approach? (2) What pitfalls threaten a multi-disciplinary approach? and (3) How are the patient'scultural background and values relevant to a proper assessment of competence? These questions are investigated in the context of analyzing and evaluating a particularly difficult case. Although focused on a specific case, the study is instructive and cautionary for any group undertaking the challenges of multi-disciplinary competence assessment.
Similar content being viewed by others
REFERENCES
Pepper-Smith R, Harvey WRC, Silberfeld M. Competency and Practical Judgment, Theoretical Medicine1996; 17(2): 135–150.
Harvey W, Pepper-Smith R, Landry, L. Competency in the Elderly, Focus on Aging 1992; 13(3): 9–12.
Chell B. Competency: What It Is, What It Isn't, and Why It Matters. In: Monagle JF, Thomasma DC, eds. Health Care Ethics: Critical Issues for the 21st Century. Rockville, MD: Aspen Publishers, 1998: 117–127.
Silberfeld M, Dickens B, Harvey WRC, Pepper-Smith R. A Competency Clinic for the Elderly, Advocates' Quarterly 1988; 10(1): 23–28.
Dickens BM. Patients' Interests and Clients' Wishes: Physicians and Lawyers in Discord, Law, Medicine & Health Care 1987; 15(3): 110–117.
Buchanan A, Brock D. Deciding for Others, The Millbank Quarterly 1986; 64(suppl. 2): 17–94.
Buchanan A, Brock D. Deciding for Others: The Ethics of Surrogate Decision Making. Cambridge, MA: Cambridge University Press, 1989.
Drane J. The Many Faces of Competency, Hastings Centre Report 1985; 15(2): 17–21.
Freedman B. Competence: Marginal and Otherwise, International Journal of Law and Psychiatry 1981; 4: 53–72.
White BC. Competence to Consent. Washington, D.C.: Georgetown University Press, 1994.
Weisstub D. Enquiry on Mental Competency: Final Report. Ontario: Queen's Publishers, 1990.
Frolik LA, Barnes AP. Elderlaw: Cases and Materials. Charlottesville, VA.: The Michie Company, 1992.
Serles HF. Schizophrenia and the Inevitability of Death, Psychiatric Quarterly 1958; 17: 631–665.
Culver CM, Gert B. The Inadequacy of Incompetence, The Millbank Quarterly 1990; 68(4): 619–625.
Drane J. Competency to Give an Informed Consent, JAMA 1984; 252(7): 925–927.
Moreno J. What Means This Consensus? Ethics Committees and Philosophical Tradition, The Journal of Clinical Ethics 1990; 1(1): 40–43.
Shenk I. Consensus – TheMeasure of Ethical Permissibility: A Response of Jonathan Moreno, The Journal of Clinical Ethics 1990; 1(1): 45.
Landry, LY. Normativity, Guardianship, and the Elderly: Some Lessons from Canadian Legislation, Theoretical Medicine and Bioethics 1999; 20(1): 69–84.
Winninger D, Pineau L. Incapacity and Autonomy: Striking a Balance, Health Law in Canada 1995; 15(3): 59–64.
Bach, M, Rock, M. Seeking Consent to Participate in Research from People Whose Ability to Make an Informed Decision Could be Questioned: The Supported Decision-Making Model, An Occasional Paper from the Roeher Institute, 1996.
Appelbaum PS, Grisso T. Assessing Patients' Capacities to Consent to Treatment, New England Journal of Medicine1988; 319(25): 1635–1638.
Brearley C. Risk and Social Work. London: Routledge and Kegan Paul, 1982.
Madigan KV, Checkland D, Silberfeld, M. Presumptions Respecting Mental Competence, Canadian Journal of Psychiatry1994; 39: 147–151.
Sutton CT, Nose MAB. American Indian Families: An Overview. In: McGoldrick M, Giordano J, Pearce JK, eds. Ethnicity & Family Therapy, 2nd edn. New York, NY: The Guilford Press, 1996: 31–44.
Hahn RA. Culture and Informed Consent: An Anthropological Perspective. In: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behaviorial Research. Making Health Care Decisions: A Report on the Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Volume Three: Appendices. Washington, D.C.: U.S. Government Printing Office, 1982.
Langrod J, Ruiz P. Cultural Aspects in Team Practice. In: Lecca PJ, McNeil JS, eds. Interdisciplinary Team Practice: Issues and Trends. New York, NY: Praeger, 1985.
Van McCrary S, Walman AT. Procedural Paternalism in Competency Determination, Law, Medicine & Health Care 1990; 18(1–2): 108–113.
Kuczewski MG. Fragmentation and Consensus: Communitarian and Casuist Bioethics. Washington, D.C.: Georgetown University Press, 1997.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Landry, L.Y. Multi-disciplinary Competence Assessment: A Case Study in Consensus and Culture. Theor Med Bioeth 20, 423–437 (1999). https://doi.org/10.1023/A:1009998008782
Issue Date:
DOI: https://doi.org/10.1023/A:1009998008782