title: Not Taking "Yes" for an Answer.
abstract: Does the practice of questioning the decision-making capacity of patients who disagree with recommended medical interventions amount to paternalism on the part of physicians who would not have raised questions about competence had these patients accepted the recommendation? Brudney and Siegler provide a nuanced argument why the practice can be both pragmatically and ethically justifiable, particularly if physicians follow a "decision tree" that they recommend for cases where disagreements occur. Nonetheless, the history of this subject shows that bioethicists have long been worried that the "outcome approach" (challenging patient's capacity because of substantive disagreements with their choices) undermines respect for autonomy, and the more refined version from Brudney and Siegler still creates some further concerns about the resulting inadequacies in communication and comprehension in the physician-patient relationship.
authors.affiliation: University of Southern California School of Law, 699 Exposition Blvd., Los Angeles, California 90089-0071 USA. acapron@law.edu.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Capron
mesh_terms: D003657:Decision Making / Q000941:ethics*; D006801:Humans; D016743:Mental Competency; D026706:Paternalism; D026684:Personal Autonomy; D010817:Physician-Patient Relations / Q000941:ethics*; D010820:Physicians / Q000941:ethics*