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- Title
THE RISK-RELATED APPROACH TO ASSESSMENT OF CAPACITY TO CONSENT TO OR REFUSE MEDICAL TREATMENT: A CRITICAL REVIEW.
- Authors
Wada, Kyoko; RudnicK, Abraham
- Abstract
Background: Capacity assessment to determine whether or not a person has adequate capacity to make a medical decision about himself or herself is important because if assessed as incapable, the person will be deprived of his or her right to self-determination. Also, the best interests of persons must be protected for those who are incapable of decision making. The risk-related approach to capacity assessment, proposed by Buchanan and Brock, is a theory that considers the expected outcomes of a decision, particularly its risks, in order to determine a benchmark of decisional capacity (threshold capacity). According to this approach, the threshold capacity should be higher when the expected risks involved in a decision are more serious compared with decisions with expected risks that are less serious. Objective: This chapter aims to clarify challenges of the risk-related approach and to resolve whether it is a sound approach. Method: We use conceptual analysis to critically examine the risk-related approach to capacity assessment and of the published debate about it. Discussion: The opponents and the proponents of the risk-related approach agree that decisional capacity: (1) is decision relative, (2) is process-related, and (3) assumes a set of values of the decision maker. They disagree on whether or not: (1) balancing of autonomy and beneficence should be done in capacity assessment, (2) expected risks should determine the level of threshold capacity, and (3) there could be various levels of threshold capacity to a particular decision. Major problems of the risk-related approach are: (1) Balancing of autonomy and beneficence in capacity assessment may potentially allow paternalism through demand for a higher threshold capacity for more serious risk. (2) There is no clear and convincing explanation for the claim that expected risks should primarily determine the level of threshold capacity. (3) This approach acknowledges a strong concern for patient well being, yet it is inconsistent or ambiguous about respecting patients' values. (4) Abilities required for each level of threshold capacity are insufficiently clear. (5) There are ambiguities within this approach, such as the claim that decisional capacity is process related despite the role of risks in this approach. Conclusion: The risk-related approach to capacity assessment is rife with challenges which may be too difficult to resolve. Hence it may not be a sound approach. Capacity assessment should be related to process, i.e., understanding pertinent information and reasoning based on a set of values that the patient holds.
- Publication
International Journal of Ethics, 2009, Vol 6, Issue 4, p351
- ISSN
1556-4444
- Publication type
Academic Journal