Handout 2: Competence: Conclusions from Discussion

1. Except possibly in dire circumstances (e.g. imminent death), a fully competent person has the refuse beneficial treatment.
2. Competence is not an all or none phenomenon; it comes in degrees. There needs therefore to be some balancing between degree of competence and the degree of harm from not treating.
3. Competence is specific to the particular issue, not global.
4. The following mental states can significantly reduce competence:
   • Cognitive impairment (e.g. dementia)
   • Mood (severely depressed and manic mood)
   • Delusions and hallucinations
5. If a person's values and decisions are unstable (i.e. they keep changing) then this may be a reason for considering the person to have reduced competence - and vice versa
6. The following do not normally reduce a person's competence:
   • The operation of psychological defense mechanisms
   • The neuroses

For further information on Treating People without their Consent:

• the UK Clinical Ethics Network web site has a detailed discussion around these issues.
• Hope T, Savulescu J, and Hendrick J - Medical Ethics and Law : the Core Curriculum. Edinburgh: Churchill Livingstone, Elsevier Science, 2003. The main text book used for the University of Oxford Medical Ethics and Law course provides more details for both teachers and their students.
• Hope T - Medical Ethics; a Very Short Introduction. Oxford: Oxford University Press, 2004.
• Ashcroft A, Lucassen A, Parker M, Verkerk M, and Widdershoven G - Case Analysis in Clinical Ethics. Cambridge: Cambridge University Press, 2005.