title: The conflation of competence and capacity in english medical law: a philosophical critique.
abstract: Ethical and legal discourse pertaining to the ability to consent to treatment and research in England operates within a dualist framework of "competence" and "capacity". This is confusing, as while there exists in England two possible senses of legal capacity -- "first person" legal capacity and "delegable" legal capacity, currently neither is formulated to bear a necessary relationship with decision-making competence. Notwithstanding this, judges and academic commentators frequently invoke competence to consent in discussions involving the validity of offering or withholding consent as a synonym for legal capacity to consent. I argue that this gives rise to a conflation, jeopardising clarity and consistency in law. This is somewhat less problematic in instances of "first-person" legal capacity that are heavily informed by criteria for decision-making competence than in the second sense of legal capacity, which is qualitatively different from decision-making competence, or with first-person legal capacity when defined in different terms from competence. The paper concludes by proposing that the soundest resolution to this problem is by making decision-making competence a necessary and sufficient condition of first-person legal capacity, affording a more scrupulous distinction between the two different forms of legal capacity that exist.
authors.affiliation: Law School and Institute for Applied Ethics, The University of Hull, Wilberforce Building, Cottingham Road, Hull, HU6 7RX, UK. p.bielby@hull.ac.uk
authors.forename: Philip
authors.initials: P
authors.lastname: Bielby
mesh_terms: D002983:Clinical Competence / Q000331:legislation & jurisprudence*; D003657:Decision Making; D004739:England; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D016743:Mental Competency / Q000331:legislation & jurisprudence*