In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges (...) on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence. (shrink)
Dans ce livre richement illustré et documenté, Marie-Jo Bonnet s'interroge sur la symbolique du couple de femmes dans l'art, en privilégiant l'exemple français, et ressuscite des figures d'artistes oubliées, comme Louise Janin, ou méconnues, telles Louise Abbéma ou Claude Cahun. Tribades, précieuses, amazones et garçonnes sont conviées à livrer leurs secrets : Marie-Jo Bonnet s'intéresse à la mise en scène du désir, longtemps orchestrée en fonction des attentes du spectateur masculin, ..
The starting point of the present paper is Bell’s notion of local causality and his own sharpening of it so as to provide for mathematical formalisation. Starting with Norsen’s analysis of this formalisation, it is subjected to a critique that reveals two crucial aspects that have so far not been properly taken into account. These are the correct understanding of the notions of sufficiency, completeness and redundancy involved; and the fact that the apparatus settings and measurement outcomes have very different (...) theoretical roles in the candidate theories under study. Both aspects are not adequately incorporated in the standard formalisation, and we will therefore do so. The upshot of our analysis is a more detailed, sharp and clean mathematical expression of the condition of local causality. A preliminary analysis of the repercussions of our proposal shows that it is able to locate exactly where and how the notions of locality and causality are involved in formalising Bell’s condition of local causality. (shrink)
In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate, and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of best interest judgments entails a risk that health care providers withdraw (...) from the decision-making process, abandoning patients to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)