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  1. (1 other version)Decision-Making Capacity.Jennifer Hawkins & Louis C. Charland - 2020 - Stanford Encyclopedia of Philosophy.
    Decision-Making Capacity First published Tue Jan 15, 2008; substantive revision Fri Aug 14, 2020 In many Western jurisdictions the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own medical decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This question has to do with what (...)
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  • Exploring the similarities and differences between medical assessments of competence and criminal responsibility.Gerben Meynen - 2009 - Medicine, Health Care and Philosophy 12 (4):443-451.
    The medical assessments of criminal responsibility and competence to consent to treatment are performed, developed and debated in distinct domains. In this paper I try to connect these domains by exploring the similarities and differences between both assessments. In my view, in both assessments a decision-making process is evaluated in relation to the possible influence of a mental disorder on this process. I will argue that, in spite of the relevance of the differences, both practices could benefit from the recognition (...)
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  • Ethics and Informed Consent of Vagus Nerve Stimulation (VNS) for Patients with Treatment-Resistant Depression (TRD).Fabrice Jotterand, Shawn M. McClintock, Archie A. Alexander & Mustafa M. Husain - 2010 - Neuroethics 3 (1):13-22.
    Since the Nuremberg trials (1947–1949), informed consent has become central for ethical practice in patient care and biomedical research. Codes of ethics emanating from the Nuremberg Code (1947) recognize the importance of protecting patients and research subjects from abuses, manipulation and deception. Informed consent empowers individuals to autonomously and voluntarily accept or reject participation in either clinical treatment or research. In some cases, however, the underlying mental or physical condition of the individual may alter his or her cognitive abilities and (...)
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  • Decision making capacity should not be decisive in emergencies.Dieneke Hubbeling - 2014 - Medicine, Health Care and Philosophy 17 (2):229-238.
    Examples of patients with anorexia nervosa, depression or borderline personality disorder who have decision-making capacity as currently operationalized, but refuse treatment, are discussed. It appears counterintuitive to respect their treatment refusal because their wish seems to be fuelled by their illness and the consequences of their refusal of treatment are severe. Some proposed solutions have focused on broadening the criteria for decision-making capacity, either in general or for specific patient groups, but these adjustments might discriminate against particular groups of patients (...)
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  • The Social Construction of Incompetency: Moving Beyond Embedded Paternalism Toward the Practice of Respect.Supriya Subramani - 2020 - Health Care Analysis 28 (3):249-265.
    This article illustrates the less-acknowledged social construction of the concept of ‘incompetency’ and draws attention to the moral concerns it raises in health care encounters in the south Indian city of Chennai. Based on data drawn from qualitative research, this study suggests that surgeons subjectively construct the idea of incompetency through their understanding of the perceived circumstantial characteristics of the patients and family members they serve. The findings indicate that surgeons often underestimate patients and family members’ capacity based on constructed (...)
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  • The Neuroscience of Decision Making and Our Standards for Assessing Competence to Consent.Steve Clarke - 2011 - Neuroethics 6 (1):189-196.
    Rapid advances in neuroscience may enable us to identify the neural correlates of ordinary decision making. Such knowledge opens up the possibility of acquiring highly accurate information about people’s competence to consent to medical procedures and to participate in medical research. Currently we are unable to determine competence to consent with accuracy and we make a number of unrealistic practical assumptions to deal with our ignorance. Here I argue that if we are able to detect competence to consent and if (...)
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  • (1 other version)Decision-making capacity.Louis C. Charland - 2011 - Stanford Encyclopedia of Philosophy.
    In many Western jurisdictions, the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own health care decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This last question has to do with what is commonly called “decisional capacity,” a central concept in health care law (...)
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  • The Cognitive Based Approach of Capacity Assessment in Psychiatry: A Philosophical Critique of the MacCAT-T. [REVIEW]Torsten Marcus Breden & Jochen Vollmann - 2004 - Health Care Analysis 12 (4):273-283.
    This article gives a brief introduction to the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and critically examines its theoretical presuppositions. On the basis of empirical, methodological and ethical critique it is emphasised that the cognitive bias that underlies the MacCAT-T assessment needs to be modified. On the one hand it has to be admitted that the operationalisation of competence in terms of value-free categories, e.g. rational decision abilities, guarantees objectivity to a great extent; but on the other hand it bears severe (...)
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  • Healthcare professionals’ dilemmas: judging patient’s decision making competence in day-to-day care of patients suffering from Korsakoff’s syndrome.Susanne van den Hooff & Martin Buijsen - 2014 - Medicine, Health Care and Philosophy 17 (4):633-640.
    Patient’s decision making competence is a widely discussed subject. Issues of competence, autonomy, well-being and protection of the patient come up every day. In this article we analyse what role PDMC plays in Dutch legislation and what dilemmas healthcare professionals may experience, notably in patients suffering from Korsakoff’s syndrome. Dilemmas emerge if professionals want to meet the requirements mentioned in Dutch law and the desires of their patients. The autonomy of the patient and the healthcare professionals’ duty to take care (...)
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  • Free will and psychiatric assessments of criminal responsibility: a parallel with informed consent. [REVIEW]Gerben Meynen - 2010 - Medicine, Health Care and Philosophy 13 (4):313-320.
    In some criminal cases a forensic psychiatrist is asked to make an assessment of the state of mind of the defendant at the time of the legally relevant act. A considerable number of people seem to hold that the basis for this assessment is that free will is required for legal responsibility, and that mental disorders can compromise free will. In fact, because of the alleged relationship between the forensic assessment and free will, researchers in forensic psychiatry also consider the (...)
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  • Living wills and substituted judgments: A critical analysis.Jos V. M. Welie - 2001 - Medicine, Health Care and Philosophy 4 (2):169-183.
    In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the power of attorney ), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of (...)
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  • The Conflation of Competence and Capacity in English Medical Law: A Philosophical Critique. [REVIEW]Philip Bielby - 2005 - Medicine, Health Care and Philosophy 8 (3):357-369.
    Ethical and legal discourse pertaining to the ability to consent to treatment and research in England operates within a dualist framework of “competence” and “capacity”. This is confusing, as while there exists in England two possible senses of legal capacity – “first person” legal capacity and “delegable” legal capacity, currently neither is formulated to bear a necessary relationship with decision-making competence. Notwithstanding this, judges and academic commentators frequently invoke competence to consent in discussions involving the validity of offering or withholding (...)
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  • Ethical and Methodological Issues in Interviewing Persons With Dementia.Ingrid Hellström, Mike Nolan, Lennart Nordenfelt & Ulla Lundh - 2007 - Nursing Ethics 14 (5):608-619.
    People with dementia have previously not been active participants in research, with ethical difficulties often being cited as the reason for this. A wider inclusion of people with dementia in research raises several ethical and methodological challenges. This article adds to the emerging debate by reflecting on the ethical and methodological issues raised during an interview study involving people with dementia and their spouses. The study sought to explore the impact of living with dementia. We argue that there is support (...)
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  • Competence in health care: an abilities-based versus a pathology-based approach.Gerben Meynen & Guy Widdershoven - 2012 - Clinical Ethics 7 (1):39-44.
    Competence is central to informed consent and, therefore, to medical practice. In this context, competence is regarded as synonymous with decision-making capacity. There is wide consensus that competence should be approached conceptually by identifying the abilities needed for decision-making capacity. Incompetence, then, is understood as a condition in which certain abilities relevant to decision-making capacity are lacking. This approach has been helpful both in theory and practice. There is, however, another approach to incompetence, namely to relate it to mental disorder. (...)
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  • Smart Socio-Technical Environments: a Paternalistic and Humanistic Management Proposal.Manuel Carabantes - 2021 - Philosophy and Technology 34 (4):1531-1544.
    One of the great dangers of our time is that the cumulative long-term action of smart socio-technical environments engineered to control thought and behavior results in an excessive loss of freedom. In response to this challenge, that we shall call humanity’s socio-technical dilemma, we outline here some fundamental ideas of a political program to control these environments, which is similar to the one proposed by Brett Frischmann and Evan Selinger. It is similar insofar as we share their paternalistic and humanistic (...)
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