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PubMed1996

Mental competence and the question of beneficent intervention.

The authors examine recent arguments purporting to show that mental incompetence (lack of decision-making capacity) is not a necessary condition for intervention in a person's best interests without consent. It is concluded that these arguments fail to show that competent wishes could justifiably be overturned. Nonetheless, it remains an open question whether accounts of decision-making capacity based solely on the notion of understanding and appreciation can adequately deal with various complexities. Different possible ways of resolving these complexities are outlined, all of which need further exploration.

Beneficence↗
PubMed2002

[Mental competence and long term care: an uncomfortable relationship].

Competency is an important concept in medical ethics as well as in law. It refers to the moral principles of self-determination and autonomy, which are of central importance in the ethics of health care. These moral principles also prevail in nursing home care. Societal prejudice concerning nursing home patients suggests that the inhabitants of a nursing home are almost by definition incompetent. We assert that such prejudice rests on certain societal delusions and misinterpretations of incompetency five of which are subsequently analysed. Next we discuss the dominant conception of competency in terms of decisional capacity. This conception is predominantly oriented towards cognitive abilities and underplays affective capacities. We confront this dominant conception with an alternative proposal of competency in terms of 'the capacity to value', which--to our opinion--more properly reflects nursing home practice concerning questions of competency. Finally we address the limitations of any concept of competency or decisional capacity in relation to the moral issues of 'good care' for demented elderly. As an alternative we draw attention to the moral perspective of the 'ethics of care'.

Aged↗
PubMed1996

[Mental competence of dementia patients to execute a will].

Instruments allowing to give a psychiatric expertise on the ability of demented people to give a will are needed. Criteria for an estimation of the course of dementing illnesses and for an increased suggestibility in coming to a decision are critically reviewed.

Aged↗
PubMed1995

[Informed consent and mental competence of the elderly in medical-scientific studies].

The decision whether a potential subject is competent or incompetent is a necessary and crucial part of conducting medical research in the elderly. The assessment of competency is required by the legal and ethical frameworks in which this research has to take place. The state of play in the national and international discussions of bills for legislation of this topic will be summarized. Especially the practical consequences of this forthcoming legislation for researchers will be explained. The ethical framework for medical research with elderly subjects will be described from a historical point of view. By means of a review of relevant literature the legal definition of competency will be operationalized and tests for its assessment will be discussed. Competency of consent is assessed by asking several questions about the essential elements of the study. The introduction of a try out of the study for a subject before asking consent ('experienced consent') is propagated as a method to optimize this consent of elderly subjects. Special conditions for giving the required information to elderly subjects, for the informed consent by proxy and for the inclusion of nursing-home residents, are discussed.

Aged↗
PubMed2002

[Mental competence and elderly care].

Competence or decision-making capacity are concepts, which are far from clear-cut. The normative consequences of an incapacity-judgment in elderly care require a balanced approach, which takes into consideration the risk of misuse in the context of the justification of interventions that are applied without consent of the patient. In this article a number of central issues in the debate on decision-making capacity are discussed. The different criteria, which are proposed to assess capacity, are discussed as well as the development of instruments in order to objectify capacity. It is concluded that the common approach towards decision-making capacity, which is strongly cognitive-oriented, is inadequate. A number of relevant aspects remain underexposed within this approach. A broader approach is explored, which takes into account the role of emotions, identity, and dialogue and deliberation. The different approaches are illustrated by way of a case example.

Adult↗