Capacity and Competence
The validity of a patient’s informed consent to medical treatment depends on several factors, including the topic of this chapter: competency. While competent patients may make any reasonable or unreasonable choices with regard to their health care, a determination of incompetence-even temporary-severely limits a person’s ability to exercise self-determination. Incompetence is sometimes referred to as a formal exception to informed consent (e.g., informed consent does not need to be sought from an incompetent patient), and other times competence is considered simply to be a core requirement for a valid consent (i.e., patients must be competent to make an informed decision). From either perspective, competence is a crucial aspect of autonomy, a term which, in the context of informed consent, may be defined as the highly valued and protected right to make independent decisions about one’s body and health care. But competence is not the only determinant of autonomy. An individual may have all the capacities necessary to make an informed decision, but fail to exercise autonomy because of coercive forces that interfere with voluntariness, or due to lack of pertinent information. It is capacity, however, not other limitations of autonomy, which is the focus of this chapter.