Area of Science:

• Medical Anthropology
• Bioethics
• Legal Medicine

Background:

• Patient refusal of medically indicated treatment presents ethical challenges.
• Assessing a patient's capacity to make decisions is crucial when their will conflicts with medical recommendations.

Purpose of the Study:

• To reformulate the patient's capacity versus physician's conviction dilemma from a medical-anthropological perspective.
• To analyze substitutive decision-making based on presumed will when mental capacity is compromised.

Main Methods:

• Analysis of medical encounters involving treatment refusal, focusing on autonomy and patient-physician dynamics.
• Examination of asymmetry in understanding medical measures and emotional resonance.
• Development of criteria for assessing mental capacity and decision-making under uncertainty.

Main Results:

• Mental capacity and legal competence enable autonomous self-care through intention judgment and consequence forecasting.
• Substitutive decisions should integrate treatment asymmetry, personal resonance, and the patient's social micro-systems.
• A framework for decision-making is proposed, balancing self-sufficiency and subsidiarity.

Conclusions:

• Anthropological insights into autonomy and substitutive decisions highlight the complexity of uncertain outcomes.
• Decision-making processes must inclusively consider all stakeholders and relevant social networks.