Health Care Analysis 24 (1):71-85 (2016)

Guy Widdershoven
VU University Amsterdam
Gerben Meynen
VU University Amsterdam
Ati Van
Universidad Nacional Autonoma de Mexico
Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder, and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient’s autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient’s and the therapist’s perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist’s approach, who used motivational interventions with a view to appealing to the patient’s responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions.
Keywords Competence  Informed consent  Decisional capacity  Autonomy  Narrative approach  Naturalistic case study  Obsessive compulsive disorder
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DOI 10.1007/s10728-014-0276-5
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References found in this work BETA

Upheavals of Thought.Martha Nussbaum - 2001 - Journal of Religious Ethics 31 (2):325-341.

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Decision-Making Capacity.Louis Charland - 2011 - Stanford Encyclopedia of Philosophy.
Decision-Making Capacity.Jennifer Hawkins & Louis C. Charland - 2020 - Stanford Encyclopedia of Philosophy.

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