title: Reflections on determining competency.
abstract: Psychiatrists are the health care professionals most frequently called upon to determine the competence of a patient to refuse treatment. The motives for determining competency vary in morally significant ways. This paper explores what I term 'the ideal motivational situation' for determining a patient's competency: a desire to respect the patient's autonomy, a desire to promote the patient's overall best interests, and a belief that when these two motives conflict the patient's autonomy should not be dismissed out of hand as a partial patient interest which is naturally outweighed by the totality of his or her interests. I claim that in a liberal, democratic society autonomy ought to trump best interests and be the sole criterion of patient competence. I conclude by offering an essentially aesthetic criterion for determining autonomy.
authors.affiliation: Department of Philosophy, University of Massachusetts/Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA. mhsilver@rcn.com
authors.forename: Mitchell
authors.initials: M
authors.lastname: Silver
mesh_terms: D006282:Health Personnel / Q000523:psychology; D006801:Humans; D016743:Mental Competency / Q000331:legislation & jurisprudence / Q000592:standards*; D009042:Motivation; D026684:Personal Autonomy; D016312:Treatment Refusal