Abstract
In many western cultures nowadays, the law requires that competent patients make their own decisions in healthcare. Incompetent patients need special protection and care, especially when it comes to medical research. In dealing with cognitively impaired, demented patients, however, clinical experience shows that these patients can still have moral capacity to make judgments about their lives, at least within certain boundaries. These cases show that the notion of competence contains socially accepted rules, variable among themselves in different situations. This variation excludes a priori acknowledgment of moral capacity, and hence a single instrument deemed to be conclusive about that capacity. The physician has to balance the rule of law with the moral interests of the patient. In our study, the notions of competence and moral capacity are researched from an empirical and a philosophical point of view. Both indicate that refinement of the legal concept of competency is necessary to assess the moral capacity of demented persons, while a reassessment of the concept of competence in relation to moral capacity should also be taken into account.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
References
Appelbaum, P.S. (1998) Ought we to require emotional capacity as part of decisional competence. Kennedy Institute of Ethics Journal 8, 377–87.
Appelbaum, P.S., Grisso, T. (1988) Assessing patients’ capacities to consent to treatment. New England Journal of Medicine 319, 1635–8.
Appelbaum, P.S., Mirkin, S., Bateman, A.L. (1982) Empirical assessment of competency to consent to psychiatric hospitalization. American Journal of Psychiatry 138, 1170–6.
Appelbaum, P.S., Roth, L. (1982) Competency to consent to research. Archives of General Psychiatry 39, 951–8.
Batista, J., Almond, R. (1973) The development of meaning in life. Psychiatry 36, 409–27.
Beauchamp, TL, Childress, J.F. (1994) Principles of Biomedical Ethics, 4th Edition. Oxford University Press, New York.
Biesaart, M.C.I.H., Hubben, J.H.(1997) Beoorderling van wilsonbekwaamheid bij mensen met een verstandelijke handicap. Stichting Philadelphia Zorg Amstelveen.
Brink, T.L., Yesavage, J.A., Heersema, P.H., et al. (1982) Screening test for geriatric depression. Clinical Gerontologist 1, 37–43.
Buchanan, A.E., Brock, D.W. (1989) Deciding For Others. The Ethics of Surrogate Decision-making. Cambridge University Press, New York.
Charland, L.C. (1998) Is Mr. Spock mentally competent? Competence to consent and emotion. Philosophy, Psychiatry, and Psychology 5, 67–81.
Charland, L.C. (1999) Appreciation and emotion: Theoretical reflections on the McArthur treatment competence study. Kennedy Institute of Ethics Journal 8, 359–76.
Chell, B. (198 8) Competency: What it is, what it isn’t, and why it matters. In Medical Ethics: A Guide for Health Professionals, Monagle, J.F., Thomasma, D.C. (Eds.). Aspen Publishers, Rockville, MD.
Cicirelli, V.G., (1997) Relationship of psychosocial and background variables to older adults’ end-of-life decisions. Journal of medical Ethics 17, 173–8.
Colby, A., Kohlberg, L., Abrahami, A. (1987) The Measurement of Moral Judgment. Cambridge University Press, Cambridge.
Damasio, A. (1994) Descartes’ Error: Emotion, Reason, and the Human Brain. Grossett and Putnam, New York.
Drane, J.F. (1985) The many faces of competency. The Hastings Center Report (VOL?), 17–21
Elliot, C., Elliot, B. (1991) From the patient’s point of view: Medical ethics and moral imagination. Journal of Medical Ethics 17, 173–8.
Fazel, S., Hope, T., Jaco by, R. (1999) Assessment of competence to complete advance directives: validation of a patient centered approach. BMJ 318, 493–7.
Folstein, M.F., Folstein, S.E., McHugh, P.R. (1975) Mini-mental state: A practical method for the clinician. Journal of Psychiatric Research 12, 198–98.
Grisso, T., Appelbaum, P.S. (1991) Mentally ill and non-mentally-ill patients’ abilities to understand informed consent disclosures for medication. Law and Human Behavior 15, 377–88.
Grisso, T., Appelbaum, P.S., Hill-Fotouhi, C. (1997) The MacCAT-T: A clinical tool to assess patients’ capacities to make treatment decisions. Psychiatry Services 48, 1415–9.
Haekens, A. (1998) Beslissingsbekwaamheid in de gerontopsychiatrische context. Leuven University Press, Leuven.
Janofsky, J.S., McCarthy, R.J., Folstein, M.F. (1992) The Hopkins Competency Assessment Test: A brief method for evaluating patients’ capacity to give informed consent. Hospital and Community Psychiatry 43, 132–6.
Kitamura, F., Tomoda, A., Tsudaka, K., et al (1998) Method for assessment of competency to consent in the mentally ill: Rationale, development, and comparison with the medically ill. International Journal of Law and Psychology 21, 223–44.
Kohlberg, L. (1984) The Psychology of Moral Development. Harper and Row, San Francisco, CA.
Marson, D.C., Chatterjee, A., Ingram, K.K., et al. (1996) Toward a neurologic model of competency: cognitive predictors of capacity to consent in Alzheimer’s disease using three different legal standards. Neurology 46, 666–72.
Marson, D.C., Cody, H.A., Ingram, K.K., et al. (1995) Neuropsychologica predictors of competency in Alzheimer’s disease using a rational reasons legal standard. Archives of Neurology 52, 955–9.
Marson, D.C., Ingram, K.K., Cody, H.A., et al (1995) Assessing the competency of patients with Alzheimer’s disease under different legal standards. Archives of Neurology 52, 949–54.
Marson, D.C., McInturff, B., Hawkins, L., et al. (1997) Consistency of physician judgments of capacity to consent in mild Alzheimer’s disease. Journal of the American Geriatric Society 45, 453–7.
Martin, B.A., Glancy, G.D. (1994) Consent to electroconvulsive therapy: Investigation of the validity of a competency questionnaire. Convulsive Therapy 10, 279–86.
Martyn, S.R. (1994) Substituted judgment, best interest, and the need for best respect. Cambridge Quarterly of Healthcare Ethics 3, 195–208.
Muncie, H.L., Magaziner, J., Hebel, R., et al. (1997) Proxies’ decisions about clinical research participation for their charges. Journal of the American Geriatric Society 45, 929–33.
Nagie, G., Silberfeld, M., O’Rourke, K. (1993) A randomized trial of a decisional aid for mental capacity assessments. Journal of Clinical Epidemilogy 46, 221–30.
Pearlin, L.I., Schooler, C. (1978) The structure of coping. Journal of Health and Social Behavior 19, 2–21.
Peijnenburg, A.J.M. (1996) Acting Against One’s Best Judgment. An Enquiry Into Practical Reasoning, Dispositions and Weakness of Will. Groningen.
President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (1982) Making Health Care Decisions. U.S. Government Printing Office, Washington, D.C.
Reker, G.T., Wong, P.T.P. (1988) Aging as an individual process: Toward a theory of personal meaning. In Emergent Theories of Aging, Birren, J.E., Bengston, V.L. (Eds.). Springer Publishing Company, New York.
Roth, L.H., Meisel, A., Lidz, C.W. (1977) Tests of competency to consent to treatment. American Journal of Psychiatry 134, 279–84.
Sachs, G.A., Stocking, C.B., Stern, R, et al (1994) Ethical aspects of dementia research: Informed consent and proxy consent. Clinical Research 42, 403–12.
Schneiderman, L.J., Kaplan, R.M., Rosenberg, E., et al. (1997) Do physicians’ own preferences for life-sustaining treatment influence their perceptions of patients’ preferences. Cambridge Quarterly of Healthcare Ethics 6, 131–7.
Schutz, A., Luchmann, T. (1974) The Structures of the Life-World. Heinemann, London.
Sherer, M., Maddux, J.E., Mercandante, B., et al. (1982) The self-efficacy scale: Construction and validation. Psychological Reports 51, 663–71.
Stanley, B., Stanley, M., Guido, J., et al. (1988) The functional competency of elderly at risk. The Gerontologist 28 (suppl), 53–8.
Wong, P.T.P., Reker, G.T., Gesser, G. (1994) Death Attitude Profile-Revised: A multidimensional measure of attitudes toward death. In Death Anxiety Handbook. Research Instrumentation and Application, Neimeyer R.A. (Ed.). Taylor and Francis, Washington, D.C.
Zweibel, N.R., Cassel, C.K. (1989) Treatment choices at the end of life: A comparison of deicions by older patients and their physician-selected proxies. The Gerontologist 29, 615–21.
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2004 Springer Science+Business Media Dordrecht
About this chapter
Cite this chapter
van Leeuwen, E., Vellinga, A. (2004). Knowing Well or Living Well. In: Thomasma, D.C., Weisstub, D.N. (eds) The Variables of Moral Capacity. International Library of Ethics, Law, and the New Medicine, vol 21. Springer, Dordrecht. https://doi.org/10.1007/978-1-4020-2552-5_14
Download citation
DOI: https://doi.org/10.1007/978-1-4020-2552-5_14
Publisher Name: Springer, Dordrecht
Print ISBN: 978-90-481-6677-0
Online ISBN: 978-1-4020-2552-5
eBook Packages: Springer Book Archive