A justifiable asymmetry
Abstract
It is a clinician's cliché that a physician only challenges a patient's capacity to make a treatment decision if that decision is not what the physician wants. Agreement is proof of decisional capacity; disagreement is proof or at least evidence of capacity's absence. It is assumed that this asymmetry cannot be justified, that the asymmetry must be a form of physicians' paternalism. Instead what is at issue when patient and physician disagree are usually two laudable impulses. The first is physicians' commitment to patients' well-being: physicians have a professional obligation as well as, ideally, a personal commitment to take care of patients--to do their best to bring about a positive medical outcome. The second impulse is common to much of human life, namely, the urge to find and to understand the source of our disagreements with one another. In this article we argue that, jointly, these impulses justify the asymmetry with regard to examining patients' capacity.
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Most scholars agree that at minimum, decisions involving greater risk to life require a higher threshold of evidence of adequate mental capacity.
“most scholars agree that at minimum, decisions involving greater risk to life require a higher threshold of evidence of adequate mental capacity (33, 37, 59, 60).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [59]
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Kane, N. B., Keene, A. R., Owen, G. S., & Kim, S. Y. H. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.946234 · Cited by 18 · see citing works
Should assessments of decision-making capacity be risk-sensitive? A systematic review
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- Authors
- Brudney, D., & Siegler, M.
- Affiliations
- University of Chicago (US)
- ORCID
- Brudney, Daniel
- Venue
- The Journal of Clinical Ethics
- Publisher
- University of Chicago Press
- Published
- 2015-06-01
- Volume
- 26
- Issue
- 2
- Pages
- 100-103
- ISSN
- 1046-7890 (ISSN-L)
- 1945-5879
- OpenAlex
- W4313125104
- Cited by
- 6
- References
- 5
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 2 · 2015: 1
- FWCI
- 0.41
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Ethics (publishedVersion)
- PubMed (publishedVersion)
- PubMed
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- decision-making capacity, patient autonomy, medical paternalism, physician-patient disagreement, clinical decision-making, informed consent
- MeSH terms
- Choice Behavior, Cultural Characteristics, Decision Making, Humans, Physician-Patient Relations, Physicians, Social Values, Mental Competency, Negotiating, Personal Autonomy, Paternalism, Dissent and Disputes
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