Competence To Consent

The book explains how assessments should be conducted and offers detailed, practice-tested interview guidelines to assist medical practitioners in this task. Numerous case studies illustrate real-life applications of the concepts and methods discussed. Grisso and Appelbaum also explore the often difficult process of making judgments about competence and describe what to do when patients' capacities are limited.".

Free and informed consent is one of the most widespread and morally important practices of modern health care; competence to consent is its cornerstone. In this book, Becky Cox White provides a concise introduction to the key practical, philosophical, and moral issues involved in competence to consent. The goals of informed consent, respect for patient autonomy and provision of beneficent care, cannot be met without a competent patient. Thus determining a patient's competence is the critical first step to informed consent. Determining competence depends on defining it, yet surprisingly, no widely accepted definition of competence exists. White identifies nine capacities that patients must exhibit to be competent. She approaches the problem from the task-oriented nature of decision making and focuses on the problems of defining competence within clinical practice. Her proposed definition is based on understanding competence as occurring in a special rather than a general context; as occurring in degrees rather than at a precise threshold; as independent of consequential appeals; and as incorporating affective as well as cognitive capacities. Combining both an ethical overview and practical guidelines, this book will be of value to health care professionals, bioethicists, and lawyers.

Free and informed consent is one of the most widespread and morally important practices of modern health care; competence to consent is its cornerstone. In this book, Becky Cox White provides a concise introduction to the key practical, philosophical, and moral issues involved in competence to consent. The goals of informed consent, respect for patient autonomy and provision of beneficent care, cannot be met without a competent patient. Thus determining a patient's competence is the critical first step to informed consent. Determining competence depends on defining it, yet surprisingly, no widely accepted definition of competence exists. White identifies nine capacities that patients must exhibit to be competent. She approaches the problem from the task-oriented nature of decision making and focuses on the problems of defining competence within clinical practice. Her proposed definition is based on understanding competence as occurring in a special rather than a general context; as occurring in degrees rather than at a precise threshold; as independent of consequential appeals; and as incorporating affective as well as cognitive capacities. Combining both an ethical overview and practical guidelines, this book will be of value to health care professionals, bioethicists, and lawyers.

A timely, authoritative discussion of an important clincial topic, this useful book outlines the history, function, nature and requirements of informed consent, focusing on patient autonomy as central to the concept. Primarily a philosophical analysis, the book also covers legal aspects, with chapters on disclosure, comprehension, and competence.

Substantial efforts have recently been made to reform the physician-patient relationship, particularly toward replacing the `silent world of doctor and patient' with informed patient participation in medical decision-making. This 'new ethos of patient autonomy' has especially insisted on the routine provision of informed consent for all medical interventions. Stronly supported by most bioethicists and the law, as well as more popular writings and expectations, it still seems clear that informed consent has, at best, been received in a lukewarm fashion by most clinicians, many simply rejecting what they commonly refer to as the `myth of informed consent'. The purpose of this book is to defuse this seemingly intractable controversy by offering an efficient and effective operational model of informed consent. This goal is pursued first by reviewing and evaluating, in detail, the agendas, arguments, and supporting materials of its proponents and detractors. A comprehensive review of empirical studies of informed consent is provided, as well as a detailed reflection on the common clinician experience with attempts at informed consent and the exercise of autonomy by patients. In the end, informed consent is recast as a management tool for pursuing clinically and ethically important goods and values that any clinician should see as meriting pursuit. Concurrently, the model incorporates a flexible, anticipatory approach that recognizes that no static, generic ritual can legitimately pursue the quite variable goods and values that may be at stake with different patients in different situations. Finally, efficiency of provision is addressed by not pursuing the unattainable and ancillary. Throughout, the traditional principle of beneficence is appealed to toward articulating an operational model of informed consent as an intervention that is likely to change outcomes at the bedside for the better.