The Concept of Competence as a Criterion to Assess the Patient's Ability to Determine Whether or Not to Designate a Representative Decision-Maker

DOI 3 Citations
  • AWAYA Tsuyoshi
    Department of Bioethics, Graduate School of Medicine, Dentistry & Pharmaceutical Sciences, Okayama University

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  • エホバの証人の輸血拒否をめぐる問題点　　代行判断者を立てるべきか否かを決定するための患者の判断能力の有無の判定基準たる判断能力の概念について

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Abstract

  Patients must have competence in order to grant consent for medical procedures. This consent is valid only when the patient is competent. If not, the consent is invalid, and in this case, the designation of a representative decision-maker will be required. It is commonly understood that the concept of competence as a criterion to assess the patient's ability to determine whether or not to designate a representative decision-maker is “the ability to understand the details, characteristics, and advantages and disadvantages of the medical procedure in his or her own body, and to determine whether or not to grant consent for the procedure on the basis of this understanding” .<br>  In this framework of understanding, the concept of competence is established on the basis of the relevant, specific medical procedure. However, with this in mind, if the relevant medical procedure is difficult for a patient to understand and decide on, it will require the patient to be highly competent, meaning an adult patient who is capable of making decisions regarding general social matters, but not the relevant, highly demanding medical procedure, may be regarded as “not competent” and his or her consent will be “invalid” . In such cases, the patient will usually rely on his or her physician's judgment or request a second opinion to grant consent regarding the relevant medical procedure. Consent given in this way cannot be called invalid, and herein lies the contradiction.<br>  To avoid this, the concept of competence as a criterion to assess the patient's ability to determine whether or not to designate a representative decision-maker shall be established on the basis of the concept of “medical practice” in general or abstract sense. That is to say, competence is “the ability to understand and make decisions regarding the concept of medical practice in general or abstract sense” .

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