Medicine, health care, and philosophy
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Med Health Care Philos · Jan 2005
Would they follow what has been laid down? Cancer patients' and healthy controls' views on adherence to advance directives compared to medical staff.
Advance directives are propagated as instruments to maintain patients' autonomy in case they can no longer decide for themselves. It has been never been examined whether patients' and healthy persons themselves are inclined to adhere to these documents. Patients' and healthy persons' views on whether instructions laid down in advance directives should be followed because that is (or is not) "the right thing to do", not because one is legally obliged to do so, were studied and compared with that of medical staff. ⋯ Cancer patients and healthy persons widely disregard instructions laid down in advance directives and consider them less binding than physicians and nursing staff do. Only a minority tends to adhere more to advance directives. To improve decision-making at the end of life when patients are no longer able to decide for themselves alternative concepts, such as advanced care planning, should be considered.
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Med Health Care Philos · Jan 2005
The conflation of competence and capacity in english medical law: a philosophical critique.
Ethical and legal discourse pertaining to the ability to consent to treatment and research in England operates within a dualist framework of "competence" and "capacity". This is confusing, as while there exists in England two possible senses of legal capacity -- "first person" legal capacity and "delegable" legal capacity, currently neither is formulated to bear a necessary relationship with decision-making competence. ⋯ This is somewhat less problematic in instances of "first-person" legal capacity that are heavily informed by criteria for decision-making competence than in the second sense of legal capacity, which is qualitatively different from decision-making competence, or with first-person legal capacity when defined in different terms from competence. The paper concludes by proposing that the soundest resolution to this problem is by making decision-making competence a necessary and sufficient condition of first-person legal capacity, affording a more scrupulous distinction between the two different forms of legal capacity that exist.