title: Consent, capacity and the right to say no.
abstract: Competence is a key component in patient consent, whether agreeing to or refusing a treatment. The law surrounding competence can be difficult to understand and interpret. We present a complex case involving a woman refusing life-saving surgical treatment. Initially considered competent by doctors, she was then deemed incompetent by a neuropsychologist, resulting in surgery against her instructions. This raised several questions regarding the notion of competence and the methods by which it is assessed and applied. We outline the legal definitions of competence: that a patient needs to understand, retain and believe the information about the treatment options; be able to weigh the information to reach a decision; and be able to communicate that decision. The assessment of competence is often complex. We discuss the medicolegal issues raised and the legal tests that need to be addressed by clinicians involved in that assessment. Finally, we present the resources and methods available to doctors confronted with difficult or complicated scenarios involving patient competence.
authors.affiliation: General, Breast and Endocrine Surgical Unit, Western Health, Melbourne, VIC, Australia. Hayden.Snow2@wh.org.au.
authors.forename: Hayden A
authors.initials: HA
authors.lastname: Snow
authors.affiliation: General, Breast and Endocrine Surgical Unit, Western Health, Melbourne, VIC, Australia.
authors.forename: Bill R
authors.initials: BR
authors.lastname: Fleming
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000628:therapy*; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D016743:Mental Competency / Q000523:psychology*; D010820:Physicians / Q000941:ethics*