Patients' Legal Competence in Treatment Decision-making

Kevin Chien-Chang Wu ； Ming-Been Lee

《Journal of Medical Education》 15卷3期 (2011/09) Pp. 222-231

https://doi.org/10.6145/jme.201109_15(3).0002

並列摘要

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.

並列關鍵字

competence ； treatment ； consent ； authenticity ； emotion ； Taiwan

參考文獻

Hart, H.(1961).The Concept of Law.Oxford:Clarendon Press.

Spaak, T.(1994).The Concept of Legal Competence: An Essay in Conceptual Analysis.Brookfield, Vt:Dartmouth.

Huang, M. Z.(1998)。General civil capacity of conduct。Rootlaw Journal。14(11)，481-536。

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.

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.