Competency and practical judgment

Theoretical Medicine

Volumn 17, Issue 2, 1996, Pages 135-150

  Pepper Smith, Robert ^a   Harvey, William R C ^a   Silberfeld, M ^a  

^a VANCOUVER ISLAND UNIVERSITY   (Canada)

Author keywords

Competency; Justice; Practical judgment; Risk evaluation

Indexed keywords

ARTICLE; COMPETENCE; HUMAN; PATIENT CARE; RISK ASSESSMENT;

AGED; COGNITION; DECISION MAKING; FEMALE; HUMANS; JUDGMENT; MALE; MENTAL COMPETENCY; MENTAL DISORDERS; SOCIAL VALUES;

EID: 0029897252     PISSN: 01679902     EISSN: None     Source Type: Journal    
DOI: 10.1007/BF00539736     Document Type: Article

References (22)

1. Working Group on Legal Issues. Legal Issues in the Care of Mentally Impaired Elderly Persons: Competence, Surrogate Management and the Protection of Rights. Canada's Mental Health 1978;26:6-11. See also Culver C, Gert B. The inadequacy of incompetence. The Milbank Quarterly 1990;68:619-643.
2. Freedman B. Competence, marginal or otherwise. International Journal of Law and Psychiatry 1981;4:53-72. See also Applebaum P, Grisso T. Assessing patients' capacity to consent to treatment. N Engl J Med 1988;319:1635-1638.
3. Dworkin, G. The Theory and Practice of Autonomy. Cambridge: Cambridge University Press, 1989.
4. The competent patient, too, is responsible for his decisions. However, one major difference between the two contexts is that in medicine the decision primarily affects the patient, whereas in law the decision, say, to contract, primarily affects both parties to the contract.
5. Working Group on Legal Issues: 7.
6. Alexander G. Legal perspectives: Issues of competency. In: Lesnoff-Caravaglia G, ed. Values, Ethics and Aging. New York: Human Sciences Press, 1985: 62-78.
7. Macklin R. Philosophical conceptions of rationality and psychiatric notions of competency. Synthese 1983;57:205-224.
8. Meyers D. Personal autonomy and the paradox of feminine socialization. The Journal of Philosophy 1987;84:619-628. See also Buchanan A, Brock R. Deciding for others. The Milbank Quarterly Suppl. 2 1986;64:17-94.
9. Macklin: 210-224.
10. Tancredi L. The mental status examination. Generations 1987;11:24-31.
11. Zuckerman C. Conclusions and guidelines for practice. Gerontologist 1987;27:67-73.
12. Ontario's Mental Health Act, R. S, O., 1980.
13. Freedman: 65-72.
14. Robins M. Practical reasoning, commitment, and rational action. The American Philosophical Quarterly 1984;21:55-68.
15. Aristotle (Apostle H. trans.). Nicomachean Ethics. Grinnell: The Peripatetic Press, 1975. See also Audi R. Intending, intentional action and desire. In: Marks J, ed. The Ways of Desire. Chicago: Precedent Publishing, 1986: 17-37.
16. All scenarios in this article are complied from a number of cases at the Competency Clinic, Baycrest Centre for Geriatric Care.
17. Culver and Gert argue that one may be justified in overruling an irrational decision made by a competent patient. Their claim, however, depends upon a sharp distinction between rationality and competence. They define competence as, "... the understanding and appreciation of information given during a properly conducted consent process." But "understanding" and "appreciation" depend on the ability to formulate relevant, rational beliefs. Thus a notion of rationality is already implicit in their definition of competence. Culver C, Gert B: 621-627.
18. Chappell N. Social policy and the elderly. In:Marshall V, ed. Aging in Canada: Social Perspectives. Don Mills: Fitzhenry and Whiteside, 1980: 35-42. See also Gutman, G. The elderly at home and in retirement housing. Ibid: 189-190.
19. Pepper-Smith R, Harvey W. Competency assessments in discharge planning and the question of intergenerational justice. Westminster Affairs 1990;3:3-5.
20. This presumption is reinforced by a legal obligation to discharge the patient to a "safe" environment.
21. Langer E. The illusion of incompetence. In: Perlmuter LC, Monty RM, eds. Choice and Perceived Control. Hillsdale: Lawrence Elbaum Associates, 1979: 301-313.
22. Brearly C. Risk and Social Work. London: Routledge and Kegan Paul, 1982: 51.