Competence to Make Treatment Decisions: A Forensic Psychology Overview
Competence to Make Treatment Decisions
Background and Definition
Definition: Competence to make treatment decisions is an extension of self-determination, encompassing an individual's right to control their own body, including the right to accept or refuse medical treatment.
Expectation: When an individual freely accepts or refuses treatment, they are generally presumed competent and therefore accountable for their choices.
Incompetence: Situations arise where an individual is deemed incompetent, necessitating an evaluation of their capacity.
Clinical Example: A 43-year-old patient refused medical treatment for glaucoma in his eyes, citing voices telling him not to. This was presented as an example of a patient deemed incompetent.
Informed Consent
Core Concept: Informed consent is the patient's permission for treatment, granted only after they have received all necessary medical information pertinent to their situation.
Necessity: It is vital to ensure patients can make well-informed choices regarding their care.
Three Requirements/Goals of Informed Consent: These principles aim to:
Promote individual autonomy: Respecting the patient's right to choose for themselves.
Encourage rational decision-making: Providing sufficient information for a reasoned choice.
Protect the safety and welfare of patients or research subjects: Ensuring awareness of potential risks and benefits.
Three Elements for Valid Informed Consent: For consent to be considered valid, it must include:
Appropriate disclosure.
A competent patient.
Voluntary consent.
Disclosure
Requirement: Disclosure is one of the three essential elements for valid informed consent.
Historical Views on Adequate Disclosure:
Pre-1972 View: Disclosure was judged based on what a reasonable clinician would typically disclose under similar circumstances. This view remained largely unchallenged until 1972.
Post-1972 View: Adequacy of disclosure began to be evaluated from the patient's perspective, focusing on what information would effectively enable the patient to make a justifiable decision.
Consistent Elements of Disclosure: Regardless of which disclosure rule is applied, the fundamental information to be disclosed remains consistent:
The nature of the recommended treatment procedure.
Its associated risks and benefits.
Available alternatives to the recommended treatment.
Four Recognized Exceptions to Informed Consent: All legal jurisdictions recognize these exceptions:
Emergency Situations: Disclosure is not required in emergencies, though what constitutes an