Patient’s Prerogative: A Defence of Self Defined Decisional Competence
Anson Fehross1, University Of Sydney; University Of New South Wales; Macquarie University Sydney 1University Of Sydney; University Of New South Wales; Macquarie University, Sydney , NSW, Australia
Abstract
In medical contexts, it is accepted that a patient has decisional capacity when they can understand, retain, use, and weigh information, and are able to communicate their decision. There is a consensus that adding further stipulations—such as the demand for a patient to act in alignment with their longstanding value commitments—is inappropriate. On this model of medical decision-making, then, we are free to change our minds, even if this involves sudden disregard for life-long commitments. A requirement that patients stay steadfast to their prior commitments would be excessively onerous.
However, a tension emerges when we consider our quotidian practices. In everyday contexts, we often interpret marked inconsistency as a defeasible sign that a person lacks decisional capacity. We recognise that fear, weakness of will, and other potentially destabilising influences can, without our knowledge, lead us to inauthentically suspend our commitments and make decisions that we do not take to be capacitious. The central issue, then, is how to reconcile the low bar for decisional capacity set by medicine and the law with more demanding self-imposed standards.
This paper proposes that patients should be granted the agency to pre-define the conditions under which they are to be deemed decisionally competent, including the power to stipulate which commitments must play a critical role in their decision-making process. This approach sidesteps unwanted medical encroachment into decision making while promoting the autonomy of individuals who fear that extraordinary circumstances may lead them to act in a manner inconsistent with their authentic selves.
Biography
Anson Fehross completed his PhD at Sydney Health Ethics, USYD. His current research includes a new model for substituted decision making integrating cognitive psychology, philosophy of medicine, and psychiatry, alongside projects exploring group decision making and consent. He is a sessional academic at the University of Sydney, University of New South Wales, and Macquarie University.