Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T12:08:16.795Z Has data issue: false hasContentIssue false
  • English
  • Français

Competence, Capacity, and Informed Consent: Beyond the Cognitive-Competence Model

Published online by Cambridge University Press:  31 March 2010

Eike-Henner W. Kluge
Eike-Henner W. Kluge*
Affiliation:
Centre on Aging, University of Victoria
*
Requests for offprints should be sent to: / Les demandes de tirés-à-part doivent être adressées à : Eike-Henner W. Kluge, Ph.D., Centre on Aging, University of Victoria, Victoria, BC V8W 3P4. (ekluge@uvic.ca)
Get access Rights & Permissions [Opens in a new window]

Abstract

Only competent persons can give informed consent to health care. Current approaches define competence in essentially cognitive terms, thereby ignoring the fact that someone may be cognitively competent yet lack the capacity to give a valid consent. I outline a more robust theory of competence that includes not only cognitive but also emotional and valuational parameters. I then distinguish competence from capacity, and indicate the role this distinction can usefully play in the extended and continuing care setting. I also show how this distinction is consistent with several recent Canadian legal decisions, and outline its usefulness in interpreting and applying relevant provincial statutes.

Résumé

Seules les personnes compétentes peuvent fournir un consentement éclairé en matière de soins de santé. Les approches actuelles définissent essentiellement la compétence en termes cognitifs, omettant ainsi le fait que quelqu'un pourrait être compétent d'un point de vue cognitif sans pour autant avoir la capacité de fournir un consentement valide. Cette étude comporte une théorie plus solide de la compétence, qui comprend non seulement les paramètres cognitifs mais également les paramètres émotionnels et subjectifs. Par la suite, elle différencie la compétence de la capacité et elle indique le rôle utile que cette distinction peut jouer dans un contexte de soins continus et de longue durée. Elle démontre également la manière dont cette distinction concorde avec plusieurs décisions juridiques canadiennes récentes, et elle souligne l'utilité de celle-ci dans l'interprétation et l'application des lois provinciales pertinentes.

Keywords

capacitycompetenceinformed consentvaluesemotionsagingcapacitécompétenceconsentement éclairévaleursémotions
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 24 , Issue 3 , Fall/Automne 2005 , pp. 295 - 304
Copyright
Copyright © Canadian Association on Gerontology 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Annas, G.J., Glantz, L.H., & Katz, B.F. (1977). Informed consent to human experimentation. Cambridge, MA: Ballinger.Google Scholar
Appelbaum, P.S. (1998). Ought we to require emotional capacity as part of decisional competence? Kennedy Institute of Ethics Journal, 8(4), 377–387.CrossRefGoogle ScholarPubMed
Beauchamp, T.L., & Childress, J.F. (2001). Principles of bio-medical ethics (5th ed.). Oxford: Oxford University Press.Google Scholar
Buchanan, A.E., & Brock, D.W. (1989). Deciding for others: The ethics of surrogate decision making. New York & Melbourne: Cambridge University Press.Google Scholar
Chopra, M.P., Weiss, D., Stinnett, J.L., & Oslin, D.W. (2003). Treatment-related decisional capacity. American Journal of Geriatric Psychiatry, 11(2), 257–258.CrossRefGoogle ScholarPubMed
Collins English Dictionary. (1981, Canadian ed.). Toronto: Wm. Collins & Sons.Google Scholar
Cope, M. (1983). The review of unconscionable bargains in equity. Australian Law Journal, 57, 279.Google Scholar
Debreu, G. (1959). Theory of value. New Haven & London: Yale University Press.Google Scholar
Downie, J.G., & Caulfield, T. (1999). Canadian health law and policy. Markham, ON: Butterworths.Google Scholar
Durkheim, E. (1973). On morality and society. Chicago: University of Chicago Press.Google Scholar
Earnst, K., Marson, D.C., & Harrell, L.E. (2000). Cognitive models of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease. Journal of the American Geriatrics Society, 48, 919–927.CrossRefGoogle ScholarPubMed
Elliott, C. (1998). Patients doubtfully capable or incapable of consent. In Kuhse, H. & Singer, P. (Eds.), A companion to bioethics (pp. 452–462). Oxford: Blackwell.Google Scholar
Engelhardt, H.T. Jr. (1986). The foundations of bioethics. Oxford: Oxford University Press.Google Scholar
Etchells, E., Darzins, P., Silberfeld, M., Singer, P.A., McKenny, J., Naglie, G., Katz, M., Guyatt, G.H., Molloy, D.W., & Strang, D. (1999). Assessment of patient capacity to consent to treatment. Journal of General Internal Medicine, 14, 27–34.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., & McHugh, P. (1975). Mini-mental state: A practical guide for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–98.CrossRefGoogle Scholar
Freedman, B. (2005). A moral theory of informed consent. In Kluge, E.-H.W. (Ed.), Readings in biomedical ethics: A Canadian perspective (3rd ed., pp. 157–166). Toronto: Pearson Education.Google Scholar
Fremgen, B.F. (2002). Medical law and ethics. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Garrett, T.M., Baillie, H.W., & Garrett, R.M. (2001). Health care ethics: Principles and problems (4th ed.). Englewood Cliffs, NJ: Prentice Hall.Google Scholar
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.CrossRefGoogle Scholar
Grisso, T., Appelbaum, P.S., & Hill-Fotouhi, C. (1997). The MacCAT-T: A clinical tool to assess patients' capacities to make treatment decisions. Psychiatric Services, 48(11), 1415–1419.Google ScholarPubMed
Hall, E. (1952). What is value? London: Routledge & Kegan Paul.Google Scholar
Harrison, C., Kenny, N.P., Sidarous, M., & Rowell, M. (1997). Bioethics for clinicians: 9. Involving children in medical decisions. Canadian Medical Association Journal, 156(6), 825–828.Google ScholarPubMed
Herzberg, F., Mausner, B., & Snyderman, B.B. (1959). Motivation to work. New York: Wiley.Google Scholar
Hodgkinson, C. (1996). Administrative philosophy. Oxford: Pergamon.Google Scholar
Hospitals Act 1989, Revised Statutes of Nova Scotia, Chapter 208, amended 1994–95, c. 7, ss. 29–37, 150; 2000, c. 6, s. 102; 2000, c. 29, ss. 15, 16; 2001, c. 5, s. 4.Google Scholar
Hyun, I. (2002). Waiver of informed consent, cultural sensitivity, and the problem of unjust families and traditions. Hastings Center Report, 32(5), 14–22.CrossRefGoogle ScholarPubMed
Independent Task Force Commissioned by the College of Physicians and Surgeons of Ontario (November 25, 1991). The final report of the Task Force on Sexual Abuse of Patients. Toronto.Google Scholar
Kant, I. (1959). Foundations of the metaphysics of morals (L.W. Beck, Trans.). New York & Indianapolis: Bobbs-Merrill. (Original work published 1785).Google Scholar
Katz, J. (1972). Experimenting with human beings. New York: Russell Sage Foundation.Google Scholar
Kirk, T., & Bersoff, D.N. (1966). How many procedural safeguards does it take to get a psychiatrist to leave the lightbulb unchanged? A due process analysis of the MacArthur Treatment Competence Study. Psychology, Public Policy and Law, 2(1), 45–72.CrossRefGoogle Scholar
Klippert, G.B. (1983). Unjust enrichment. Toronto: Butterworths.Google Scholar
Maslow, A.H. (1943). A theory of human motivation. Psychological Review, 50, 370–396.CrossRefGoogle Scholar
Mental Health Act, R.S.O. 1990, c. M.Google Scholar
Moore, G.E. (1962). Principia ethica. Cambridge: Cambridge University Press.Google Scholar
Moye, J., Karel, M.J., Azar, A.R., & Gurrera, R.J. (2004). Capacity to consent to treatment: Empirical comparison of three instruments in older adults with and without dementia. Gerontologist, 44(2), 166–175.CrossRefGoogle ScholarPubMed
Norberg v. Wynrib, [1992] 2 S.C.R. 226, 12 C.C.L.T. (2d) 1.Google Scholar
Oates, L. (2000). The courts' role in decisions about medical treatment. British Medical Journal, 321, 1282–1284.CrossRefGoogle ScholarPubMed
O'Neill, O. (2001). Practical principles and practical judgement. Hastings Center Report, 31(3), 1–23.CrossRefGoogle Scholar
Oxford Paperback Dictionary (1994). (4th ed.). Oxford: Oxford University Press.Google Scholar
Pareto, V. (1909). Manuel d'économie politique. Paris: Girard.Google Scholar
Parsons, T., & Stills, E. (1962). Towards a general theory of action. New York: Harper.Google Scholar
Personal Directives Act, 2000, R.S.A., c. P.Google Scholar
Peters, R.S. (1960). The concept of motivation. London: Routledge & Kegan Paul.Google Scholar
Picard, E., & Robertson, G. (1996). Legal liability of doctors and hospitals in Canada. Toronto: Carswell.Google Scholar
Reibl v. Hughes, [1980] 2 S.C.R. 880, 14 C.C.L.T. 1.Google Scholar
Roberts, L.W. (2002). Informed consent and the capacity for voluntarism. American Journal of Psychiatry, 159(5), 705–712.CrossRefGoogle ScholarPubMed
Starson v. Swayze [2003] 1 S.C.R. 722.Google Scholar
Stauch, M., Wheat, K., & Tingle, J. (1998). Sourcebook on medical law. London: Cavendish.Google Scholar
Steers, R.M., & Porter, L.W. (1975). Motivation and work behaviour. New York: McGraw-Hill.Google Scholar
Substitute Decisions Act, S.O. 1992, c. 30.Google Scholar
Tri-Council (1998). Ethical conduct for research involving humans. Article 2.2. Ottawa: Queen's Printer.Google Scholar
Universal Declaration of Human Rights, GA Res. 217(III), UN GAOR, 3rd Sess., Supp. No. 13, UN Doc. A/810 (1948) 71.Google Scholar
University of Arkansas for Medical Sciences Institutional Review Board (2004). Special populations. Policy no. 17.12. Little Rock: Author.Google Scholar
Urmson, J.O. (1968). The emotive theory of ethics. London: Methuen.Google Scholar
Veatch, R.M. (2003). The basics of bioethics. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Waters, D. (1986). Banks, fiduciary obligations and unconscionable transactions. Canadian Bar Review, 65, 37.Google Scholar