David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Ezio Di Nucci
Jonathan Jenkins Ichikawa
Jack Alan Reynolds
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Medicine, Health Care and Philosophy 4 (2):127-138 (2001)
In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence
|Keywords||autonomy competence decision making incompetence patient rights|
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Citations of this work BETA
Torsten Marcus Breden & Jochen Vollmann (2004). The Cognitive Based Approach of Capacity Assessment in Psychiatry: A Philosophical Critique of the MacCAT-T. [REVIEW] Health Care Analysis 12 (4):273-283.
Gerben Meynen (2009). Exploring the Similarities and Differences Between Medical Assessments of Competence and Criminal Responsibility. Medicine, Health Care and Philosophy 12 (4):443-451.
Fabrice Jotterand, Shawn M. McClintock, Archie A. Alexander & Mustafa M. Husain (2010). Ethics and Informed Consent of Vagus Nerve Stimulation (VNS) for Patients with Treatment-Resistant Depression (TRD). Neuroethics 3 (1):13-22.
Gerben Meynen (2010). Free Will and Psychiatric Assessments of Criminal Responsibility: A Parallel with Informed Consent. [REVIEW] Medicine, Health Care and Philosophy 13 (4):313-320.
Philip Bielby (2005). The Conflation of Competence and Capacity in English Medical Law: A Philosophical Critique. [REVIEW] Medicine, Health Care and Philosophy 8 (3):357-369.
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