competence

Introduction

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.

Additional terms

• autonomy
• decision-making capacity; decisional capacity
• medical ethics