Decision-making with psychiatrically impaired patients. A collaborative endeavor

The courts and the physicians are engaged in assuring quality medical care to competent and incompetent patients. The evolving policy of informed consent improves medical decisionmaking by insisting that the patient's values be involved. The principle of beneficence, which the courts support in practice without using the word, is a compromise between strong paternalism and the unachievable goal of true autonomy in incompetent patients. The role of physicians in this model is that of technical advisor and facilitator rather than actual decisionmaker. Medical schools train physicians for this role anyway. In order for the patient or guardian to be a genuine decision-maker, he must be involved in the evaluation and treatment all along, not just at the point at which a consent form must be signed.