Chapter 5.A.2 (or 3.A.2)  The Patient Whose Competence Is Uncertain

Additional facts for Lane v. Candura

One psychiatrist testified that Ms. Candura lacked decision making capacity, in part because she would not discuss her reasons for refusal with him and because he thought her gangrene might be compromising her thinking.  Another psychiatrist, who was able to elicit Ms. Canduraís reasons for refusing treatment, testified that she possessed decision making capacity.

Assessing Competence, note 1

For an interesting discussion of religious beliefs and decision making capacity, see Adrienne M. Martin, Tales Publicly Allowed: Competence, Capacity, and Religious Beliefs, 37(1) Hastings Center Rep. 33 (2007) (arguing that religious beliefs that interfere with understanding may make the patient incapacitated but that respect for the patientís religious values may lead us to accept the patientís decision).

Assessing Competence, note 2

Not all states recognize a mature minor doctrine.  For example, a federal district court in Georgia concluded that Georgia state law grants decision making capacity only in certain statutorily specified situations (e.g., minors who are married, pregnant or who have children) but does not include a mature minor doctrine.  Novak v. Cobb County-Kennestone Hosp. Auth., 849 F. Supp. 1559 (N.D. Ga.  1994).  Other states have not decided one way or another whether maturity serves as the basis for decision making capacity for a minor.  In re Conner, 140 P.3d 1167 (Ore. Ct. App. 2006).

For further discussion, see Kimberly M. Mutcherson, Whose Body Is It Anyway? An Updated Model of Healthcare Decision-Making Rights for Adolescents, 14 Cornell J. L. & Pub. Pol'y 251 (2005).

Assessing Competence, note 3

See also Peter H. Ditto, et al., Stability of Older Adultsí Preferences for Life-Sustaining Medical Treatment, 22 Health Psych. 605 (2003) (finding moderate stability in treatment preferences over two-year time period).  For patients whose health status changes, however, their treatment preferences also may change.  As health status worsens and patients see that their quality of life is better than they had thought it would be, patients become more accepting of treatments that provide lower levels of benefit or greater levels of discomfort.  Terri R. Fried, et al., Prospective Study of Health Status Preferences and Changes in Preferences Over Time in Older Adults, 166 Arch. Intern. Med. 890 (2006).