PHIL 2390H Chapter Notes - Chapter 2: 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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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.
