A/Prof. Neil Pickering1, A/Prof Giles Newton-Howes, Dr Simon Walker
1Bioethics Centre University of Otago, New Zealand
Abstract:
In this paper we argue that if the cognitive difficulties inherent in a decision are a necessary part of the assessment of decision-making competence, then neither of the main approaches to competence assessment (viz. externalism and internalism) are coherent as they stand.
We suggest that these inherent difficulties are a necessary part of the assessment of competence.
Externalism is the claim that the more harmful a person’s proposed choice the higher the standard of decision-making competence should be set. But this doesn’t directly assess inherent difficulty, and the degree of harm is not indirectly related to difficulty either.
Internalism is the claim that assessment of decision-making competence should be based entirely on internal (cognitive) processes such as understanding. This is not coherent because the difficulties inherent in a decision cannot be assessed by looking at the internal cognitive processes of a person’s mind.