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Consent, capacity and the right to say no
Author(s) -
Snow Hayden A,
Fleming Bill R
Publication year - 2014
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja13.10901
Subject(s) - competence (human resources) , informed consent , psychology , medicine , medical education , social psychology , alternative medicine , pathology
Summary 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.