According to what we propose to call "the competence model," competence is a necessary condition for valid informed consent. If a person is not competent to make a treatment decision, the decision must be made by a substitute decision-maker on her behalf. Recent reports of various United Nations human rights bodies claim that article 12 of the Convention on the Rights of Persons with Disabilities involves a wholesale rejection of this model, regardless of whether the model is based on a status, outcome, or functional approach to competence. The alleged rationale of this rejection is that denying persons the right to make their own treatment decisions based on an assessment of competence necessarily discriminates against persons with mental disorders. Based on a philosophical account of the nature of discrimination, we argue that a version of the competence model that combines supported decision-making with a functional approach to competence does not discriminate against persons with mental disorders. Furthermore, we argue that status- and outcome-based versions of the competence model are discriminatory.

中文翻译：

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知情同意过程中的平等：对精神障碍患者的同意、替代决策和歧视的能力

根据我们提议的“能力模型”，能力是有效知情同意的必要条件。如果一个人没有能力做出治疗决定，则必须由替代决策者代表她做出决定。联合国各人权机构最近的报告称，《残疾人权利公约》第 12 条涉及对这种模式的全面拒绝，无论该模式是基于地位、结果还是基于职能的能力方法。这种拒绝的所谓理由是，剥夺人们根据能力评估做出自己的治疗决定的权利必然歧视精神障碍患者。基于对歧视本质的哲学解释，我们认为，将辅助决策与能力方法相结合的能力模型版本不会歧视精神障碍患者。此外，我们认为基于状态和结果的能力模型版本具有歧视性。