Journal of advanced nursing
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This paper presents a discussion on the assessment of mental competence of patients and relatives in the health care setting. Their decision-making ability is explored with particular reference to the giving of consent for nursing intervention and medical treatment. It is suggested that, in addition to obvious psychological or neurological disorders, decision-making ability will be influenced by psychological stress and the ability to communicate effectively. It highlights the ambiguity of mental competence assessment and concludes that such assessments will, to a greater or lesser extent, be subject to value-laden judgement.
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Universal prescriptivism is a recently developed moral decision-making theory that combines utilitarian and Kantian theories with two levels of moral thinking. A combined approach offers a creative solution to the weaknesses inherent in traditional moral theories. The paper describes the theory and discusses important implications for nursing education, practical ethical decision-making, and research. The relationship of an ethical theory of caring to traditional moral theory is discussed.