Hastings Cent Rep. 2023 Jul;53(4):30-43. doi: 10.1002/hast.1500.
Should the assessment of decision-making capacity (DMC) be risk sensitive, that is, should the threshold for DMC vary with risk? The debate over this question is now nearly five decades old. To many, the idea that DMC assessments should be risk sensitive is intuitive and commonsense. To others, the idea is paternalistic or incoherent, or both; they argue that the riskiness of a given decision should increase the epistemic scrutiny in the evaluation of DMC, not increase the threshold for DMC. We respond to the critics' main concerns by providing a comprehensive account of how risk-sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations.
对于决策能力（DMC）的评估是否应该具有风险敏感性，也就是说，DMC 的阈值是否应该随风险而变化？对于这个问题的争论已经有近五十年的历史了。对于许多人来说，DMC 评估应该具有风险敏感性的想法是直观的和常识性的。对于其他人来说，这种想法是家长式的或不连贯的，或者两者兼而有之；他们认为，给定决策的风险应该增加对 DMC 评估的认知审查，而不是增加 DMC 的阈值。我们通过提供一个全面的解释来回应批评者的主要关注点，说明风险敏感的 DMC 如何具有一致性、避免家长式作风，并最好地实现 DMC 评估的认知目标。
