Patients' Legal Competence in Treatment Decision-making

10.6145/jme.201109_15(3).0002

Kevin Chien-Chang Wu；Ming-Been Lee

competence ； treatment ； consent ； authenticity ； emotion ； Taiwan

Journal of Medical Education

15卷3期（2011 / 09 / 01）

222 - 231

英文

In recent decades, informed consent has become a core issue in medical ethics. Of the five elements of informed consent, namely: competence, information, voluntariness, comprehension, and decision (consent or refusal), competence has drawn much clinical and academic attention because it forms the basis of autonomy. The MacArthur Treatment Competence Study is currently the most thorough study in this field and it proposes four functional abilities to assess competence: (1) communicating a stable choice, (2) understanding, (3) appreciation, and (4) reasoning. However, this cognitive-based approach to competence remains debatable and the best approach to competence in treatment decision making in Taiwan's legal context is still unclear. This paper first explores the concepts and formulations of competence. Second, the characteristics and construct of competence as proposed by the MacArthur Treatment Competence Study's competence formula are delineated. Third, debates on the above formula, especially on those about emotion and authenticity, are addressed. Fourth, it focuses on how to set the threshold of competence in treatment decisions. Lastly, to conclude, it explores and proposes the substance and procedure of competence assessment in Taiwan's legal context.

1. Anderers, S. J.(1990).A model for determining competency in guardianship proceedings.Ment Phys Disabil Law Rep,14,107-114.
2. Appelbaum, P. S.(2007).Assessment of patients' competence to consent to treatment.N Engl J Med,357(18),1834-1840.
3. Appelbaum, P. S.,Grisso, T.(1995).The MacArthur Treatment Competence Study. I..Law Hum Behav,19(2),105-126.
4. Beauchamp, T. L.,Childress, J. F.(2009).Childress JF: Principles of Biomedical Ethics.New York:Oxford University Press.
5. Breden, T. M.,Vollmann, J.(2004).The cognitive based approach of capacity assessment in psychiatry: A philosophical critique of the MacCAT-T.Health Care Analysis,12(4),273-283.
6. Buchanan, A.,Brock, D. W.(1986).Deciding for others.Milbank Q,64(Suppl 2),17-94.
7. Charland, L. C.(2006).Anorexia and the MacCAT-T test for mental competence: Validity, value, and emotion.Philosophy, Psychiatry, & Psychology,13(4),283-287.
8. DeMarco, J. P.(2002).Competence and paternalism.Bioethics,16(3),231-245.
9. Fuh, J. L.(2008)。Dementia in Taiwan: Current status。Taiwan Geriatrics & Gerontology，3(3)，169-181。
10. Grisso, T.(ed.)(2003).Evaluating Competencies: Forensic Assessments and Instruments.New York:Kluwer Academic.
11. Grisso, T.,Appelbaum, P. S.(2006).Appreciating anorexia: Decisional capacity and the role of values.Philosophy, Psychiatry, & Psychology,13(4),293-297.
12. Grisso, T.,Appelbaum, P. S.(1998).Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals.New York:Oxford University Press.
13. Hart, H.(1961).The Concept of Law.Oxford:Clarendon Press.
14. Ho, H.、Tsuang, M. M.、Lin, H. N.(1997)。Results of forensic psychiatric examinations and court sentencing。Taiwanese Journal of Psychiatry，11(3)，262-268。
15. Huang, M. Z.(1998)。General civil capacity of conduct。Rootlaw Journal，14(11)，481-536。
16. Lichtenberg, P.(ed.)(1999).Handbook of Assessment in Clinical Gerontology.New York:Wiley.
17. Maeckelberghe, E.(2004).Feminist ethic of care: A third alternative approach.Health Care Analysis,12(4),317-327.
18. Okonkwo, O. C.,Griffith, H. R.,Copeland, J. N.(2008).Medical decision-making capacity in mild cognitive impairment: A 3-year longitudinal study.Neurology,71(19),1474-1480.
19. Owen, G. S.,David, A. S.,Richardson, G.(2008).Mental capacity, diagnosis and insight in psychiatric inpatients: A cross-sectional study.Psychol Med,39(08),1389.
20. Roth, L.,Meisel, A.,Lidz, C.(1977).Tests of competency to consent to treatment.Amercan Journal of Psychiatry,134,279-284.
21. Sales, B. D.(ed.),Shuman, D. W.(ed.)(1994).Law, Mental Health, and Mental Disorders.New York:Brooks/Cole Publishing.
22. Smyer, M.(ed.),Schaie, K. W.(ed.),Kapp, M. P.(ed.)(1996).Older Adulats Decision Making and the Law.New York:Springer.
23. Spaak, T.(1994).The Concept of Legal Competence: An Essay in Conceptual Analysis.Brookfield, Vt:Dartmouth.
24. Tan, J.,Stewart, A.,Fitzpatrick, R.(2006).Competence to make treatment decisions in anorexia nervosa: Thinking processes and values.Philosophy, Psychiatry, & Psychology,13(4),267-282.
25. Weindling, P.(2001).The origins of informed consent: The International Scientific Commission on Medical War Crimes, and the Nuremberg Code.Bulltin of the History of Medicine,75(1),37-71.
26. Wilks, I.(1999).Asymmetrical competence.Bioethics,13(2),154-159.
27. Wilson, R. F.(1997).Hospital ethics committes as the forum of last resort: An idea whose time has not come.North Carolina Law Review,76,353-406.
28. Wu, C. C.(2000)。Taipei City，National Taiwan University。

1. 蕭婷文,吳建昌(2017).The Legal Criteria and Trend of Compulsory Psychiatric Admission: A Mini-review and Implications for Taiwan.臺灣精神醫學,31(1),38-48+ii.