Mental competence and the question of beneficent intervention

Theoretical Medicine

Volumn 17, Issue 2, 1996, Pages 121-134

  Checkland, David ^a   Silberfeld, Michel ^a  

^a RYERSON UNIVERSITY   (Canada)

Author keywords

Capacity; Decision making; Mental competence; Paternalism; Rationality; Risk; Understanding

Indexed keywords

HUMAN; MEDICAL DECISION MAKING; PATIENT CARE; REVIEW;

ANALYTICAL APPROACH; COMPETENCE; MORAL POLICY; PROFESSIONAL PATIENT RELATIONSHIP;

BENEFICENCE; DECISION MAKING; DEPRESSIVE DISORDER; HUMANS; INFORMED CONSENT; MALE; MENTAL COMPETENCY; MOTIVATION; PATERNALISM; TREATMENT REFUSAL;

EID: 0029895655     PISSN: 01679902     EISSN: None     Source Type: Journal    
DOI: 10.1007/BF00539735     Document Type: Review

References (43)

1. Culver CM, Gert B. The inadequacy of incompetence. Milbank Q 1990;64:4.
2. Elliot C. Competence as accountability. J Clin Ethics 1991;2:3.
3. Culver and Gert. Inadequacy: 619.
4. Elliot. Accountability: 168.
5. Brock DW. Letter to the Editor. J Clin Ethics 1992;3:1.
6. Brock seems to recognize the difference when he too speaks of "decisional authority". A charitable reading would find him speaking as he does not because he conflates the question of decisional authority with that of justifying intervention, but because he is primarily concerned with these issues in the case of competent wishes, and not incompetent ones.
7. Culver and Gert. Inadequacy: 624.
8. Ibid: 612.
9. Ibid: 622.
10. Ibid: 624.
11. Ibid: 628.
12. Ibid: 628.
13. Ibid: 620.
14. Ibid: 621.
15. Drane JF. The many faces of competency. Hast Cntr Rprt 1985:15.
16. Buchanan A, Brock DW. Deciding for Others. Cambridge University Press. New York, 1989.
17. Culver and Gert. Inadequacy: 620.
18. Ibid: 632.
19. Ibid: 6254.
20. Gert B. Rationality, Human Nature and Lists. Ethics 100, 1990: 380.
21. Ibid: 280.
22. Ibid: 297.
23. Hurley SL. Natural Reasons: Personality and Policy. Oxford University Press. New York: 1989.
24. Culver and Gert. Inadequacy: 622.
25. We hope it is obvious that the situation-relativities implied in any doctrine of non-global or decision-specific competence do not involve anything like a sliding-scale: they are in what must be understood.
26. Davidson D. Essays on Actions and Events. Oxford University Press, 1980.
27. Davidson D. Inquiries into Truth and Interpretation. Oxford University Press, 1984.
28. Gert. Rationality: 279.
29. Ibid: 288.
30. Hurley. Reasons: 24.
31. Gert. Ratinality: 289.
32. Dennet DC. Elbow Room. MIT Press. Cambridge, Mass., 1984.
33. Honore AM. Can and can't. Mind 73: 464.
34. Gert and Duggan find this use "completely implausible" when offered as a general account of ability words. We agree. (Gert B, Duggan TJ. Free will as the ability to will. Nous 13, 1979.)
35. Consider a basketball player who leads the league in shooting percentage, and is particularly adept at shooting from "bad" angles, etc., now taking a shot with one second to go in the championship game with his team behind by the value of the shot. This person may, by virtue of history in the face of pressure or death threats from gamblers, etc., be a pretty unlikely bet to make a shot that, in other circumstances, he would be very likely to make. The source or nature of the interference with his general ability, of course, matters in all sorts of ways.
36. The sense of "rational control" here cannot deny that the mere occurrence of the desire is not directly under the control of the agent. Rather, it is the capacity to rationalize the desire in a wider context of beliefs and desires that is at issue.
37. More needs to be said about what the phrase "all-things-considered" commits us to. We see no good reason to treat it as so substantive a notion that it allows another to force consideration of values not supported by a person's own history.
38. Culver and Gert. Inadequacy: 626.
39. In the present case is the person in dread of ECT competent? It is hard to say without further information regarding the degree of excitation and ability to "take in" what others try to communicate. But neither, we suggest, are our interventionist intuitions likely to be so strong here. Such cases, on the other hand, will often generate an obligation on the part of health care professionals to go to some lengths to help a competent person deal with his fear.
40. Hurley. Reasons: 46-50.
41. Brock. Letter.
42. See, e.g., The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behaviourial Research Making Health Care Decisions. Washington, DC. US Govt Printing Office 1982 or Appelbaum PS and Grisso T. Assessing patient's capacities to consent to treatment. NE J Med 319: 25, 1635-1638.
43. We have not discussed Car Elliot's arguments against the dominant view. Elliot's suggestion that the competent person is the person accountable for her actions, while generally true, seems to us unilluminating because accountability and competence will generally presuppose the very same abilities. It is discussion of these that is needed.