Whether in healthcare, financial, legal, or any other area of decision making, the stakes for both persons and professionals in competence definitions are substantial. Identifying and labeling someone as incompetent can be stigmatizing and deprives the person of self-determination. Legal and healthcare delivery systems are then confronted with, and disrupted by, the need for surrogate decision making for the incapacitated or incompetent person. On the other hand, failure to protect the incapacitated person from making erroneous and harmful decisions (e.g., refusing necessary medical care) may not honor the person's best interests. The question then is when and how to respect people's choices and maximize their decision-making autonomy while protecting them from their own harmful choices (Drane). In most cases in the healthcare system, clinicians agree that the person should, or should not, be considered competent, even if there is no universal consensus on how much rationality and understanding are sufficient for the person to be considered legally competent and granted authority to decide for him- or herself. Still, there are other cases in which judgments about the person's decision-making capacity are problematic, and clinicians, administrators, patients, families, and the courts become involved in emotionally charged disputes about how to manage the person's medical care. Such cases are unlikely to abate in the future as long as our society continues to value, and attempts to balance, autonomy and beneficence.
ROBERT M. WETTSTEIN (1 995) BIBLIOGRAPHY REVISED
SEE ALSO: Advance Directives and Advance Care Planning; Aging and the Aged: Healthcare and Research Issues; Autonomy; Informed Consent; Law and Bioethics; Mental Illness; Patients'Rights; Pediatrics, Adolescents; Professional-Patient Relationship; Research Policy: Subjects; Responsibility; Sexism; Surrogate Decision-Making
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