Competence as Accountability
Journal of Clinical Ethics. 1991 Fall; 2(3): 167-171.
Few problems in medical ethics are as intractable as that of patient competence. And few are as pervasive. The questions of when and why patients are incapable of making their own decisions pervade clinical decisions in a number of different areas: pediatrics, clinical trials and experimentation, terminal care, rational suicide, and treatment refusal at all levels....These questions have been needlessly confused by a lack of clarity about what exactly constitutes competence, starting with the very influential 1982 report by the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research and continuing in most current accounts of competence. I will offer a more precise account, arguing that patient competence (or decision-making capacity) should be considered as the ability to make decisions about one's medical care for which one can be legitimately considered accountable. I will first point out some of the problems associated with two influential models of competence, the President's Commission report and the so-called sliding scale approach to competence, and I will then show how the account that I offer can remedy some of the defects in each of these models.
Accountability; Advisory Committees; Autonomy; Behavioral Research; Beneficence; Clinical Trials; Competence; Consent; Decision Making; Ethics; Evaluation; Health; Health Care; Informed Consent; Medical Ethics; Medicine; Patient Care; Patients; Pediatrics; Research; Risks and Benefits; Standards; Suicide; Terminal Care; Treatment Refusal;
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Elliott, Carl; Elliott, Britt (1991-12)This paper concerns the difficulties of imagining the subjective point of view of another human being, and the relevance of these difficulties to medical decisions. It explores especially the difficulties of imagining ...