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competence

Legal determination that the patient has the right to make decisions regarding health care, including life & death. Competence or capacity to make a decision is dependent upon the decision in question. For patients unable to express a decision, incompetence is present by definition. For an individual who can express a decision, a general clinical rule is that the patient should be able to demonstrate an understanding of the proposed alternatives, & the consequences of the various options, then reasonably explain why he/she has chosen the expressed decision. The determination is quite subjective & objective testing is of limited value. Determination of competence is also dependent upon what is at stake (or whether or not the decision is reasonable). For example,a patient who declines a risky or uncomfortable procedure when the benefits of the procedure are minor or marginal is generally not questioned further.

Related

autonomy decision-making capacity; decisional capacity medical ethics

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 582
  2. Kapp M & Finucane T. Decision Making, In: Comprehensive Geriatric Assessment, Osterweil et al eds, McGraw-Hill, New York, pg 589
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  4. Appelbaum PS. Clinical practice. Assessment of patients' competence to consent to treatment. N Engl J Med. 2007 Nov 1;357(18):1834-40. PMID: 17978292