The inadequacy of incompetence

Patients' competence to make medical decisions, analysts frequently hold, is the key concept for determining whether those decisions may be overruled. Competence, however, is neither a necessary nor a sufficient condition for concluding when it is morally admissible to supersede refusals of treatment. People may be able to reach kinds of decisions involving immediate medical consequences, but not ones entailing long-term outcomes. Open recognition of the limited but important exceptions to the principle of never overruling competent patients' refusal of care would better preserve their autonomy than unduly accepting the absoluteness of the principle.