PHIL 2390H Lecture Notes - Lecture 3: Tylenol (Brand), Headache, Lifesaving
26 Jun 2018
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Chapter 2 Management of Medical Information
Standards of Competence
Allen E. Buchanan and Dan W. Brock p.26-29
IDifferent Standards of Competence
A. A minimal Standard of Competence
oThe patient merely can express a preference
oThis standard respects every expressed choice of a patient, and so is not in fact a
criterion of competent choice at all.
oDisregards whether defects or mistakes are present in the reasoning process
leading to the choice, whether the choice is in accord with the patient’s own
conception of his or her good, and whether the choice would be harmful to the
patient.
oFails to provide any protection for patient well-being, and it is incentive to the
way the value of self-determination itself varies both with the nature of the
decision to be made and with differences in people’s capacities to choose in
accordance with their conceptions of their own good.
B. An outcome Standard of Competence
oAt the other extreme are standards that look solely to the content or outcome of
the decision –i.e. the standard that the choice be a reasonable one, or be what
other reasonable or rational persons would choose.
oFailure of the patient’s choice to match some such allegedly objective outcome
standard of choice entails that it is an incompetent choice.
oMaximally protects patient well-being, but fails to adequately respect patient self-
determination.
Self-determination: his or her interest in defining, revising over time, and
pursuing his or her own particular conception of the good life.
oIgnores the patient’s own distinctive conception of the good and may constitute
enforcement of unjustified ideals or unjustifiably substitute another’s conception
of what is best for the patient.
C. A Process Standard of Decision-Making Competence
oAn adequate standard of competence will focus primarily not on the content of the
patient’s decision but on the process of the reasoning that leads up to that
decision.
oA process standard must set a level of reasoning required for the patient to be
competent.
How well must the patient understand and reason to be competent?
oHow certain must those persons evaluating competence be about how well the
patient has understood and reasoned in coming to a decision?
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2
II Relation of the Process Standard of Competence to Expected Harms and Benefits
- No single standard of competence –no single answer to the questions above –can be
adequate for all decisions.
oThe degree of expected harm from choices made at a given level of understanding
and reasoning can vary from none to the most serious, including major disability
or death.
oThe importance or value to the patient of self-determination can vary depending
on the choice being made.
- Just because a patient is competent to consent to a treatment, it does not follow that the
patient is competent to refuse it, and vice versa.
oi.e. consent to a low-risk lifesaving procedure by an otherwise healthy individual
should require only a minimal level of competence, but refusal of that same
procedure by such an individual should require the highest level of competence.
- The competence evaluation addresses the process of the patient’s reasoning, whereas the
degree of defectiveness and limitation of, and uncertainty about, that process that is
compatible with competence depends in significant part on the likely harm to the
patient’s well-being of accepting his or her choice.
Guided Readings
I suppose the big question is why is competence important. We know already from our
discussions of informed consent, that competence is an important component of informed
consent, but competence is also crucial to understanding of 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 reviewed 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, circumstances might affect a patient's competence to make medical
choices.
Review the definition of competence in the introduction to chapter 2. Do you agree with this
definition? What aspects of that definition need to be further clarified, or explained to get a full
picture of what it means to be competent to make medical decisions?
In "Standards of Competence"Allen E. Buchanan and Dan W. Brock outline 3 standards of
competence.
- What are the three standards of competence outlined by the authors?
- 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?
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Allen e. buchanan and dan w. brock p. 26-29. Relation of the process standard of competence to expected harms and benefits. I suppose the big question is why is competence important. We know already from our discussions of informed consent, that competence is an important component of informed consent, but competence is also crucial to understanding of 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 reviewed 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, circumstances might affect a patient"s competence to make medical choices. Review the definition of competence in the introduction to chapter 2.
