Brock Dan W
Bioethics. 1991 Apr;5(2):105-12. doi: 10.1111/j.1467-8519.1991.tb00151.x.
Mark Wicclair criticizes Allen Buchanan's and my claim that determining an appropriate level of competence (Wicclair substitutes "decisional capacity" for "competence", the import of which I note briefly below) for health care treatment decisionmaking involves balancing respecting a patient's self-determination and protecting his or her well-being. The most important implication of this balancing is that a standard of competence should vary in significant part with the effects for the patient's well-being of accepting his or her choice. Wicclair's criticisms take two main forms. First, he considers and rejects four of the positive reasons we offer in support of a risk-related standard. Second, in rejecting our fourth reason he argues that a risk-related standard leads to faulty competence determinations -- too high a standard in some cases and too low a standard in others. If he is correct, there are no positive reasons for adopting a risk-related standard and there are as well specific reasons not to adopt such a standard in order to avoid mistaken competence determinations. My response will address both sorts of criticisms in turn.
马克·威克莱尔批评了艾伦·布坎南和我的观点，即确定医疗治疗决策的适当能力水平（威克莱尔用“决策能力”代替“能力”，我将在下文简要说明其含义）涉及平衡尊重患者的自我决定权和保护其福祉。这种平衡最重要的含义是，能力标准在很大程度上应随接受患者选择对其福祉的影响而变化。威克莱尔的批评主要有两种形式。第一，他考虑并驳回了我们提出的支持与风险相关标准的四个正面理由。第二，在驳回我们的第四个理由时，他认为与风险相关的标准会导致错误的能力判定——在某些情况下标准过高，而在其他情况下标准过低。如果他是正确的，那么就没有采用与风险相关标准的正面理由，而且也有不采用这种标准的具体理由，以避免错误的能力判定。我的回应将依次处理这两种批评。
