Patient Decision-Making Capacity and Risk

Abstract

Although certain requisites of patient decision-making competency are generally agreed upon, there is no universally recognized standard. Wicclair, of the University of West Virginia Department of Philosophy, offers two reasons why a single standard should not be determined. First, competency is variable according to the decision at hand, i.e., task-related. Second, arguments in support of risk-related criteria fail. Wicclair challenges claims that a risk-related standard is legally the most feasible, is supported by the doctrine of informed consent, is consistent with everyday competence judgments, and achieves the best compromise between patient autonomy and concern for patient well-being. He argues that where risk is high, such a standard threatens unattainable requirements for competency; and where it is low, offers no set minimum, resulting in overly weak competency standards. Wicclair concludes that the standard of decision-making capacity should not vary by risk perceived. (KIE abstract)