Compassion, control, and decisions about competency

A competent patient has the right to refuse any medical intervention. However, hospitalized patients who refuse treatment sometimes find their competency challenged. The author describes the grounds for deciding that an elderly woman who resisted amputation "lacked capacity" to refuse the intervention, so that custody was conditionally awarded to a state social service department. Questions are raised about the evaluation process. The author suggests that the standard for finding a patient not competent to refuse treatment should be no less than generalized incompetence, including clear evidence that a patient is uninformable on emotionally neutral issues and cognitively incapable of making ordinary decisions on matters unrelated to the crisis at hand.