first and foremost question that must be resolved in deciding whether one
will respect or override a patient’s refusal. There is no single definition
of competency, and there are many different ways of stating the concepts
involved in that term.
The term competent is nothing more than a label we place on a person
when we conclude that we should allow him or her to make the decision at
issue. Generally, we apply the label to the person who understands his or
her condition and the consequences of the choices and whose reasons make
sense to us. Sometimes, however, especially in cases of religious refusals and
First Amendment considerations, we apply the term competent to persons who
base their refusal on irrational beliefs as long as those beliefs are within our
common religious experience and do not seem too strange.
In making determinations of competency and in forcing treatment on others,
we are engaging in serious matters. We should not avoid these decisions,
however. We must use our experience of the human condition and our best
judgment in the attempt to make proper decisions. As long as we make these
decisions with proper motives and a proper understanding of the task, we
make them properly. Although these decisions might be difficult in individual
cases, we should make them without unnecessary concern or doubt, because in
doing so we are doing all that can properly be done. We are, after all, simply
human beings attempting to make very difficult decisions relating to other
QUESTIONS FOR DISCUSSION
1. What demographic changes or healthcare practices might increase the
need to determine patient competence in the future?
2. How do the principles of patient autonomy and beneficence conflict when
making healthcare decisions that run counter to the patient’s choice?
3. Why is it important for a healthcare professional to have a guideline for
deciding patient competence?
4. In competency cases, how important is it to listen to the patient and
clarify his or her wishes? Would you want more than one person to
interview the patient?
5. What ethical theories support making a treatment decision for a patient
even when he or she does not want treatment?
FOOD FOR THOUGHT
The issue of determining patient competency is never easy and will continue
to be challenging to healthcare professionals. Consider the changes that the
aging of the American population will bring. After considering this chapter and
the principles of ethics you have studied, what is the best advice you can give
about determining patient competency in a way that is ethical?