Module 3 Who is Competent PDF

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**Module 3: Who is Competent? ** Whǖ is competence impoƛt5nt? We knoǐ Ĺƛom ouƛ discussions oĹ inĹoƛmed consent,  th5t competence is 5n impoƛt5nt component oĹ inĹoƛmed consent, but competence is  5lso cƛuci5l to undeƛst5ndinĺ 5 numbeƛ oĹ conceƛns in biomedic5l ethics.  Fund5ment5l...

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Module 3: Who is Competent? Why is competence important? We know from our discussions of informed consent, that competence is an important component of informed consent, but competence is also crucial to understanding a number of concerns in biomedical ethics. Fundamentally the principle of respect for autonomy is premised on the individual in question being competent to make their own choices.  When it comes to medical decision-making there are many things which might impact our ability to make medical decisions. As indicated in the mini-lecture, we might wonder whether pain can affect a patient's competence to make choices about their own health care. Consider for yourself what other conditions and circumstances might affect a patient's competence to make medical choices  What are the three standards of competence outlined by the authors? ● Minimal Standard of competence ● A Outcome standard of competence ● A process standard of decision-making competence ○ Minimal Standard: ■ 1) enough for the patient to express preference ■ 2) no concern for defects of mistakes in reason ■ 3) focuses entirely on patient self-determination, no regard for patient well-being ○ Outcome Standard: ■ 1) look to the outcome of the decision or its content ■ 2) assess against "objective" standards ■ 3) no regard for patient self-determination, all regard for well-being ○ Process Standard: ■ A balance between patient self-determination and well-being by focusing on the process of reasoning that produces the decision. What principles of biomedical ethics are supported or undermined by each of these standards?

What problems can you identify with each of these standards? ● Buchanan and Brock seem to be arguing for a modified process standard, but one that is relative to the decision being made What do they mean by a modified process standard? ● They argue that the level of understanding is relative to risk and harm: ○ "The greater the risk relative to other alternatives – where risk is a function of the severity of the expected harm and the probability of its occurrence – the greater the level of communication, understanding and reasoning skills required for the competence to make that decision." p.34  ● Complexity also affects the standard of competence required How is it that the authors conclude that a patient could be competent enough to consent to treatment but not competent enough to refuse treatment? Do you agree with their assessment? The authors outline several possible defects in understanding that might undermine competence: “factual misunderstanding” (p. 34) ○ What are some examples of conditions or situations which might impede factual understanding? ● “failure of the patient's choice to be based on his or her underlying and enduring aims and values” (p. 35) ○ What are some examples of conditions or situations that might result in a choice which does not reflect a patient's long held values? ○ Do these kinds of errors provide good reason to suggest that a patient is not competent to make medical decisions? What would the author’s say?

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