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Competence and paternalism.

Joseph P DeMarco1

  • 1Cleveland State University, Department of Philosophy, Cleveland, Ohio 44115, USA. jdemarco@popmail.csuohio.edu

Bioethics
|September 5, 2002
PubMed
Summary
This summary is machine-generated.

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This study argues against a sliding scale for assessing patient competence, proposing a fixed standard instead. Greater evidence of competence is required when medical risks, such as amputation, are higher.

Area of Science:

  • Bioethics
  • Medical Ethics
  • Decision-Making Capacity

Background:

  • Bioethicists debate the concept of a sliding scale for competence, where higher risk necessitates greater demonstrated competence.
  • This approach is supported by arguments from legal cases, common language, and judgments about competence.

Purpose of the Study:

  • To challenge the sliding scale notion of competence in bioethics.
  • To advocate for a fixed standard of competence, requiring clearer evidence with increased risk.

Main Methods:

  • Critically analyze arguments supporting a sliding scale for competence, including those by Buchanan, Brock, Wilkes, and Feinberg.
  • Examine two clinical cases involving amputation to illustrate the proposed standard.
  • Present a fixed concept of competence with a risk-adjusted evidence requirement.
Keywords:
Analytical ApproachProfessional Patient Relationship

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Main Results:

  • The sliding scale notion of competence is found to be inadequately supported by legal, linguistic, and judgmental evidence.
  • A fixed competence standard, demanding clearer evidence for high-risk procedures, aligns better with sound ethical decision-making.
  • Clinical case analyses support the efficacy of the proposed fixed competence model.

Conclusions:

  • A fixed standard of competence, rather than a sliding scale, is ethically preferable in bioethics.
  • Increased risk necessitates a higher threshold of evidence for patient competence.
  • This approach better supports morally sound decisions in complex medical scenarios.