Competence

Abstract

Competence is a key concept of bioethics with rich interdisciplinary and practical connotations. After offering basic conceptual clarification, its clinical significance is illustrated by referring to empirical studies. Exploring the ethical dimension of competence reveals that it cannot be studied without acknowledging the doctrine of informed consent and, more recently, the rule of shared decision making in medicine and health care. The definition of the ideal concept of competence is reflected including the standards and norms that it is setting as well as the exceptions to the rule – i.e., people with diminished competence comprised in large groups of the population such as young children, old and demented people, cognitively handicapped persons, or severely ill patients. They, too, have rights and deserve being respected, even in the absence of (full) decisional competence. In bioethics, medical ethics, and clinical ethics, the topic of competence plays an important role regarding patient rights, shaping the attitude of health-care professionals, and influencing the ideas of appropriate treatment decision making. Practical challenges concern the assessment of a person’s competence. In a global perspective, it is suggested to open up the spectrum of competency research beyond individualistic concepts toward acknowledging the difficulties and needs prevailing in developing countries.