User:Esaiter/Competence to make treatment decisions

Competence to make treatment decisions
In the United States, an individual must be deemed competent to provide informed consent for medical treatment. If someone is incompetent, they cannot provide informed consent, and another decision-maker (such as a guardian or health care proxy) may be identified in their stead. Competence to make treatment decisions stems from legal precedent about the right to refuse psychiatric medication and treatment. In the context of informed consent, most adults are assumed to be competent unless otherwise specified. Should the adult suffer from severe mental illness or intellectual disability, their competence may be questioned. Still, adults from these more vulnerable populations are not incompetent by default and their competency should be evaluated on a case-by-case basis. There are specific tools that a psychologist may use to evaluate competence to make treatment decisions, such as the MacArthur Competency Assessment Tool-Treatment.

If an individual's competence to make treatment decisions is questioned, their understanding, appreciation, and decision-making process may be evaluated.

Understanding
A patient should be able to understand information about their treatment or medical condition which would be disclosed to them during informed consent. If a patient does not possess the ability to understand the information disclosed to them, they may not be competent to make treatment decisions. Some adults who may lack this ability to understand might be patients who suffer from amnesia, dementia, or those with intellectual disabilities.

Appreciation
A patient should then be able to not only understand information about their treatment or medical condition, but also appreciate how that information may apply to them. This is more than understanding the information in the abstract; the patient should be able to appreciate the consequences of consenting to the treatment, investigating alternate treatment options, or refusing the treatment, and how they would be directly impacted. A patient who experiences delusions which are out of touch with reality may understand that antipsychotic medication is a traditional treatment for schizophrenia, but believe that in their case, they are not mentally ill and taking this medicine would make them catatonic.

Reasonable decision-making process
This aspect of competence is related to the cognition underscoring the patient's decision-making process. The patient must be able to rationally weigh the benefits and risks associated with their medical condition, consenting to treatment, assessing alternative treatments, and/or refusing treatment. An evaluator may question a patient's competence if some substantial consequence (e.g., limb amputation) is thought as less important than something relatively minor (e.g., hair loss). If the decision to refuse treatment appears to stem directly from mental illness, this may indicate a patient's decision-making process is not rational or reasonable.