Abstract

According to a standard account of patient decision-making capacity (DMC), patients can provide ethically valid consent or refusal only if they are able to understand and appreciate their medical condition and can comparatively evaluate all offered treatment options. We argue instead that some patient refusals can be capacitated, and therefore ethically authoritative, without meeting the strict criteria of this standard account—what we call comparative DMC. We describe how patients may possess burdens-based DMC for refusal if they have an overriding objection to at least one burden associated with each treatment option or goals-based DMC for refusal if they have an overriding goal that is inconsistent with treatment. The overridingness of a patient’s objections to burdens, or of their commitment to a goal, can justify the moral authority of their refusal, even when a patient lacks some of the cognitive capacities that standard accounts of DMC involve.

摘要

根据患者决策能力 (DMC) 的标准说明，只有当患者能够理解和理解他们的医疗状况并且能够比较评估所有提供的治疗方案时，他们才能提供道德上有效的同意或拒绝。相反，我们争辩说，一些患者的拒绝可以被授权，因此在道德上具有权威性，而不需要满足这个标准账户的严格标准——我们称之为比较DMC。我们描述了如果患者对与每种治疗方案相关的至少一个负担有压倒性的反对，或者如果他们有一个与治疗不一致的压倒一切的目标，那么他们如何拥有基于负担的 DMC 以拒绝。这患者对负担的反对或他们对目标的承诺的压倒一切可以证明他们拒绝的道德权威是正当的，即使患者缺乏标准的 DMC 描述所涉及的某些认知能力。