Am J Psychiatry 1984; 141:53-58
Copyright © 1984 by American Psychiatric Association
Compassion, control, and decisions about competency
V Abernethy
A competent patient has the right to refuse any medical intervention.
However, hospitalized patients who refuse treatment sometimes find their
competency challenged. The author describes the grounds for deciding that
an elderly woman who resisted amputation "lacked capacity" to refuse the
intervention, so that custody was conditionally awarded to a state social
service department. Questions are raised about the evaluation process. The
author suggests that the standard for finding a patient not competent to
refuse treatment should be no less than generalized incompetence, including
clear evidence that a patient is uninformable on emotionally neutral issues
and cognitively incapable of making ordinary decisions on matters unrelated
to the crisis at hand.
