Whiting Demian
Philosophy, University of Hull, Hull, HU6 7RX, UK,
Health Care Anal. 2015 Jun;23(2):181-96. doi: 10.1007/s10728-013-0258-z.
In this paper I get clearer on the considerations that ought to inform the evaluation and development of medico-legal competency criteria-where this is taken to be a question regarding the abilities that ought to be needed for a patient to be found competent in medico-legal contexts. In the "Decisional Competency in Medico-Legal Contexts" section I explore how the question regarding the abilities that ought to be needed for decisional competence is to be interpreted. I begin by considering an interpretation that takes the question to be asking about the abilities needed to satisfy an idealized view of competent decision-making, according to which decisional competency is a matter of possessing those abilities or attributes that are needed to engage in good or effective or, perhaps, substantially autonomous or rational decision-making. The view has some plausibility-it accords with the way decisional competency is understood in a number of everyday contexts-but fails as an interpretation of the question regarding the abilities that should be needed for decisional competence in medico-legal contexts. Nevertheless, consideration of why it is mistaken suggests a more accurate interpretation and points the way in which the question regarding the evaluation of medico-legal competency criteria is to be answered. Building on other scholarly work in the area, I outline in the "Primary and Secondary Requirements" section several requirements that decisional competence criteria ought to satisfy. Then, in the "Applying the Framework" section, I say something about the extent to which medico-legal competency criteria, as well as some models of decisional competency proposed in the academic literature, fulfil those requirements.
在本文中，我更清楚地阐述了那些应该为医学法律能力标准的评估和制定提供依据的考量因素——这里将其视为一个关于患者在医学法律背景下被认定具备能力所需能力的问题。在“医学法律背景下的决策能力”部分，我探讨了关于决策能力所需能力的问题应如何解读。我首先考虑一种解读方式，即该问题是在询问满足理想化的胜任决策观点所需的能力，根据这种观点，决策能力在于具备那些参与良好或有效决策、或者或许是高度自主或理性决策所需的能力或属性。这种观点有一定的合理性——它与在许多日常情境中对决策能力的理解方式相符——但作为对医学法律背景下决策能力所需能力问题的一种解读却并不成立。然而，思考它为何错误能引出一种更准确的解读，并指出回答关于医学法律能力标准评估问题的方向。基于该领域的其他学术研究，我在“主要和次要要求 ”部分概述了决策能力标准应满足的若干要求。然后，在“应用该框架”部分，我阐述了医学法律能力标准以及学术文献中提出的一些决策能力模型在多大程度上满足这些要求。
