In this paper I get clearer on the considerations that ought to inform the evaluation and development of medico-legal competency criteria—where this is taken to be a question regarding the abilities that ought to be needed for a patient to be found competent in medico-legal contexts. In the “Decisional Competency in Medico-Legal Contexts” section I explore how the question regarding the abilities that ought to be needed for decisional competence is to be interpreted. I begin by considering an (...) interpretation that takes the question to be asking about the abilities needed to satisfy an idealized view of competent decision-making, according to which decisional competency is a matter of possessing those abilities or attributes that are needed to engage in good or effective or, perhaps, substantially autonomous or rational decision-making. The view has some plausibility—it accords with the way decisional competency is understood in a number of everyday contexts—but fails as an interpretation of the question regarding the abilities that should be needed for decisional competence in medico-legal contexts. Nevertheless, consideration of why it is mistaken suggests a more accurate interpretation and points the way in which the question regarding the evaluation of medico-legal competency criteria is to be answered. Building on other scholarly work in the area, I outline in the “Primary and Secondary Requirements” section several requirements that decisional competence criteria ought to satisfy. Then, in the “Applying the Framework” section, I say something about the extent to which medico-legal competency criteria, as well as some models of decisional competency proposed in the academic literature, fulfil those requirements. (shrink)

:A good deal of contemporary moral nonconsequentialism assumes that agents have perfect knowledge about the various features and consequences of their options. This assumption is unrealistic. More often than not, moral agents can only assess with a certain degree of probability the factual circumstances that are morally relevant for their decision making. My aim in this essay is to discuss the problem of moral decisions under risk from the point of view of nonconsequentialism. Basically, I analyze how objective moral principles (...) can be transformed into subjective, decisional prescriptions, and argue that the standard nonconsequentialist approach to moral decision making, which focuses on probability thresholds, is wrong. In accordance with the fundamental postulates of nonconsequentialism, I seek to solve the problem of risk in moral choice by proposing a theory about the marginal moral value of various options. Actions can vary along various dimensions, and each of these dimensions can offer a different moral value function. Nonconsequentialist marginalism can level the playing field with consequentialism. Whereas consequentialism can simply borrow the notion of expected utility from economics, nonconsequentialism must introduce the notion of expectational obligation to formulate a general principle of moral choice under risk. I finally suggest that further empirical work is needed to delineate the shape of various moral value functions that are critical for applying the general principle of moral decision making under risk to well-known cases. View HTML Send article to KindleTo send this article to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle. Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service.DECISIONAL NONCONSEQUENTIALISM AND THE RISK SENSITIVITY OF OBLIGATIONVolume 32, Issue 2Horacio Spector DOI: https://doi.org/10.1017/S0265052516000121Your Kindle email address Please provide your Kindle [email protected]@kindle.com Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Dropbox To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox. DECISIONAL NONCONSEQUENTIALISM AND THE RISK SENSITIVITY OF OBLIGATIONVolume 32, Issue 2Horacio Spector DOI: https://doi.org/10.1017/S0265052516000121Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Send article to Google Drive To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive. DECISIONAL NONCONSEQUENTIALISM AND THE RISK SENSITIVITY OF OBLIGATIONVolume 32, Issue 2Horacio Spector DOI: https://doi.org/10.1017/S0265052516000121Available formats PDF Please select a format to send. By using this service, you agree that you will only keep articles for personal use, and will not openly distribute them via Dropbox, Google Drive or other file sharing services. Please confirm that you accept the terms of use. Cancel Send ×Export citation Request permission. (shrink)

Propósito: la adecuación del esfuerzo terapéutico es una decisión clínica basada en la evidencia que pretende evitar la futilidad médica. Se han señalado diferentes factores que pueden influir en esta toma de decisiones los cuales se relacionan con el paciente, el profesional médico que toma de las decisiones, barreras del sistema, cultura y economía, entre otros. El presente estudio pretende identificar aquellos factores que influyen en los médicos especialistas que laboran en la institución referente del cáncer en Colombia, a fin (...) de planear acciones que mejoren el abordaje de la toma de decisiones con respecto a la adecuación del esfuerzo terapéutico en pacientes con cáncer. Metodología: diseño cualitativo basado en 13 entrevistas en profundidad a médicos especialistas del Instituto Nacional de Cancerología de Colombia. Resultados: participaron 3 mujeres y 10 hombres, con un promedio de edad de 36 años, 7 pertenecientes a la especialidad de oncología de adultos, 2 a oncohematología pediátrica, 1 a cuidados intensivos de adultos y 3 a cuidados intensivos pediátricos. Los factores hallados se agruparon en cuatro categorías: 1) conocimiento, 2) aspectos relacionados con la toma de decisiones, 3) quién decide, 4) tipo de decisión que se toma; a su vez, estas categorías se agruparon en temas que hacen alusión a los factores que influyen en la toma de decisiones de los especialistas para adecuar los esfuerzos terapéuticos. Conclusión: la adecuación de los esfuerzos terapéuticos es importante para evitar procedimientos médicos fútiles que prolonguen el sufrimiento. Se evidenciaron algunos factores que influyen en la toma de decisiones de los especialistas: falta de preparación de los profesionales de salud en el tema de toma de decisiones al final de la vida, uso reducido de escalas que permitan mejorar la información del pronóstico y desconocimiento sobre voluntades anticipadas; estos son algunos de aquellos factores que deben fortalecerse para generar acciones que mejoren el abordaje de esta temática. (shrink)

Addiction of the variety discussed in this chapter, is a condition that by its very nature compromises decision-making capacity across the decisional spectrum. The impairment is present not only at moments of withdrawal and intoxication, but at all stages of the active addictive cycle, as long as the pathological dispositions to overvalue addictive drugs remain entrenched and operative. In light of this entrenched and pervasive reorientation in pathological values, it seems reasonable to question the unilateral presumption of capacity for (...) cases of this sort. The reason is that there is an important, but restricted, sense in which the addicted individuals in question are not ‘responsible’ for their decisions regarding drug use. The high likelihood of relapse means that, as a clinical matter of fact, they are usually not accountable. At the same time, clinical experience also suggests that we should treat addicted individuals as if they are responsible because that empowerment is crucial to their recovery. In the end, there is probably only one safe course of action to take when faced with such a difficult situation. This is to suspend the unilateral global presumption of capacity and instead assess decision-making capacity on a case-by-case basis, with careful monitoring and encouragement. (shrink)

Do adolescents have the decisional capacity of adults? Or, are they in crucial ways still immature, that is, are they deficient decisionmakers? This questi.

En este artículo se parte de la asunción común de que los ordenamientos jurídicos modernos exigen que las decisiones judiciales deben ser fundamentadas. Algunos filósofos del derecho, partiendo de esta exigencia práctica, han desarrollado diversas propuestas teóricas para explicar la estructura y el funcionamiento de las decisiones judiciales, pero también para ofrecer criterios de valoración que permitan determinar si cierta decisión judicial se encuentra propiamente justificada. En este artículo, en primer lugar, se reconstruyen algunas de estas propuestas teóricas y se (...) clasifican en dos modelos diferentes: la teoría estrecha del silogismo judicial y la teoría amplia del silogismo judicial. En segundo lugar, se explicita un complicado problema que aqueja a estos modelos, a saber, la paradoja del seguimiento de reglas. En tercer lugar, se propone una manera de disolver este espinoso problema y, a su vez, de dar un paso adelante en la construcción de una nueva línea explicativa, que aquí llamaré “teoría pragmatista de las decisiones judiciales”. Por último, se ofrece una manera plausible de acomodar conceptualmente los aportes teóricos más relevantes de cada uno de los tres enfoques. (shrink)

“No lo hicieron extraterrestres; fueron personas como nosotros[1]” comentaban en el programa especial del InfoK[2] sobre el Holocausto. Kitson, Steward y Husbands lo justifican: una de las mayores dificultades del alumnado que aprende contenidos históricos es entender por qué las personas de un contexto hicieron lo que hicieron. Desde la enseñanza de la historia se ha reflexionado ampliamente sobre las causalidades relacionadas con ciertos hechos históricos, pero se ha dado menos peso a analizar las interpretaciones sobre la agencia histórica. En (...) este artículo nos proponemos repasar y concretar la conceptualización que desde la didáctica de las ciencias sociales se ha dado a la agencia histórica en la comprensión de las causalidades para entender las decisiones y las responsabilidades de las personas en contextos como el del Holocausto para entender que todas las personas somos agentes sociales, de cambio y continuidad y, por tanto, agentes históricas. (shrink)

Procrastination as putting off until tomorrow what one had intended to do today is well-known tendency in everyday life. In an attempt to understand the character of procrastination in different life-domains, a large body of research has been accumulated over the last decades. This article was aimed to evaluate a specific decisional procrastination of school-to-work transition that is treated as maturity postponement. Two studies are reported examining SWT procrastination defined as career indecision among Polish students graduating universities. In Study (...) 1, attitudinal and identity statuses were analyzed as correlates of career procrastination. A path analysis conducted for the model, which was aimed to explain the influence of career self-efficacy and occupational commitment on career indecision, revealed its very good fitness. Those two independent variables explain 10% of career indecision variance. Stepwise multiple regression analyses conducted to ascertain relationship of five identity statuses to procrastination measure showed that Commitment Making and Ruminative Exploration are strongest predictor variables. In study 2, the stepwise multiple regression analyses conducted to ascertain the independent relationship of each of Big Five personality factor revealed that Neuroticism and Extraversion accounts of the most of explained variance of school-to-work transition procrastination. (shrink)

This pilot randomized controlled trial explored the feasibility, acceptability, and potential utility of an intervention to improve the decisional capacity (DC) for research consent/assent among youth living with HIV (YLWH). We randomly assigned 30 YLWH aged 13–24 to a control (paper-based) or intervention (multimedia) consent/assent condition. Using a between- and within-subjects design, participants completed a demographic questionnaire and measures of DC, acceptability/feasibility, and voluntary self-consent perceptions after undergoing a hypothetical consent/assent process for a biomedical HIV study. Findings suggest participants (...) found the intervention feasible and acceptable. Participants in the intervention condition scored higher on a DC measure; however, scores did not meet the predetermined cutoff score for adequate DC in either group. The potential implications of these findings for research with youth, including YLWH, are discussed. (shrink)

The purpose of this article is threefold: (a) to describe the relevant ethical and legal issues associated with decisional capacity among minors and to discuss the importance of these concepts for children and adolescents living with HIV, (b) to provide a framework for assessing the decisional capacity of children and adolescents with HIV, and (c) to present a model for thinking about how to use this assessment data to guide action along the protection-autonomy continuum.

El equipo multidisciplinario especializado, con ayudas diagnósticas avanzadas, brinda, en las unidades de cuidados intensivos neonatales, atención a los recién nacidos en estado crítico de salud. No comprender la muerte como un acontecimiento natural dificulta establecer un equilibrio en el tratamiento proporcionado y exige una juiciosa valoración de los beneficios y cargas basados en una ética responsable. La literatura sugiere que se necesita, en relación con los aspectos bioéticos de la práctica clínica, de capacitación, participación y presencia permanente de los (...) profesionales de la salud en la toma de decisiones en conjunto con las madres, de tal forma que se proporcione consuelo a la familia del neonato. (shrink)

Este artículo establece un marco para considerar los aspectos éticos relacionados con el tratamiento involuntario en personas con: a) una discapacidad intelectual o del desarrollo; b) un impedimento neurológico progresivo, y c) un estado mental comprometido desde el punto de vista del cuidador. Los diferentes momentos de decision de los tres grupos se describen aquí, así como los impactos potenciales en los cuidadores respecto de las decisiones de los pacientes.Mientras hay algunos aspectos de las capacidades que pueden variar entre estos (...) grupos, otros son transversales y comunes a ellos. Es importante recalcar que todos los cuidadores requieren ser reconocidos y apoyados en las funciones que realizan. Necesitan, por ende, información basada en evidencias y de fuentes confiables sobre las opciones disponibles, para cumplir el rol queles toca y ver cómo velar por el propio cuidado de su salud y bienestar para, así, poder cuidar mejor a las personas con las que conviven. (shrink)

El ámbito decisional y la representación ciudadana encuentran nuevos desafíos en el contexto de la deflación de la subjetividad moderna y el desmoronamiento del fundamento político. Con la aparición del Big Data y el _machine learning_ aplicado al espacio de las decisiones políticas aparecen nuevas modalidades de la administración de la vida, las que, a su vez, generan nuevos registros de control sobre los cuerpos en una sociedad pos-disciplinaría que convive con la tecnología. Siguiendo a E. Sadin, J. Danaher (...) y K. O’Neil, se expondrán argumentos en contra de la ideológica creencia que confiaría en que la toma de decisiones algocráticas sería capaz de eliminar el prejuicio humano y el fallo en las decisiones políticas. De este modo, la Algocracia instancia una tensión a nivel político-normativo frente a diferentes teorías de la democracia, no reconociendo la opacidad de las fórmulas con las que se pretende tomar decisiones en el plano de lo social. _Palabras clave: _Decisiones políticas, representación ciudadana, gobernanza, algocracia, sociedad post-disciplinaria. (shrink)

In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context of (...) class='Hi'>decisional capacity assessments, the difficulties to reconcile 1) and 2) with 3) which they at the same time seem to imply. Having clarified the centrality of a cogent notion of mental disorder for addressing these difficulties, I comment on three promising lines of inquiry about the nature and scope of autonomy that emerge from the following chapters. (shrink)

Los avances en biomedicina amplían cada vez más las posibilidades de curar a enfermos críticos. Las decisiones sobre terapias por aplicar deben tener presente el riesgo de caer en el llamado “encarnizamiento terapéutico”. Aunque ya se ha escrito bastante sobre los criterios básicos que se deben tener en cuenta, aún quedan numerosas dudas a la hora de tomar las decisiones. Un aspecto no menor es la necesidad de objetivar los distintos elementos por ponderar, sin olvidar que hay aspectos subjetivos que (...) son muy importantes. En el presente artículo se presenta una manera de combinar los aspectos objetivos y subjetivos, para llegar a un equilibro adecuado y práctico, que sea razonable y respete la autonomía del paciente. (shrink)

La enseñanza moral católica afirma que es necesario el consentimiento de los pacientes para autorizar las intervenciones sanitariasque les afectan, pero no especifica las condiciones para obtener dicho consentimiento o evaluar la capacidad de decisión. Aquí se presentan los artículos recogidos en este número que los autores han desarrollado a partir de las presentaciones que hicieron durante un coloquio reciente de la Asociación Internacional de Bioética Católica (IACB) celebrado en Quebec, Canadá. Contribuyen a promover el pensamiento ético sobre la capacidad (...) de toma dedecisiones y el consentimiento. De diversas formas, piden que se respete la dignidad de todos los pacientes y que se promueva su participación tanto como sea posible en la toma de decisiones sobre su salud. Consideran que la toma de decisiones es relacional y abarca una variedad de capacidades. Examinan el papel de los miembros de la familia y de otros partidarios de la toma de decisiones en la promoción de las capacidades de los pacientes, cuya condición de salud mental o discapacidad les impide a menudo cumplir con los estándares clínicos y legales típicos para la capacidad de toma de decisiones. (shrink)

In this article I note two ways in which current assessments of patients’ decisional capacity rest on disputable philosophical assumptions. The first disputable assumption concerns the nature of practical reason; the second concerns patients’ articulation of their preferences. I do not argue that clinical practice should be changed. Still, relying on disputable philosophical assumptions can distort the description of such practice. It would be good for philosophers and philosophically oriented clinicians to work with a philosophically accurate account of clinical (...) practice. Moreover, every so often more accurate description might make for better practice. (shrink)

The ethics of involving persons with cognitive impairments and/or mental illness in research continues to gain academic and public attention. Concerns about the ability of such persons to provide ethically and legally valid consent and about the appropriateness of their research involvement in certain categories of studies have resulted in publication of guidelines, position papers, standards, and court decisions. These analyses address not only when and from whom informed consent may be obtained but also under what conditions it is ethically (...) permissible to involve persons in research who are too decisionally impaired to provide their own consent.It is an advance in research ethics that there is heightened appreciation of the need for greater protections for, and possibly research participation limitations on, persons unable to give their own consent. In our zeal to protect potentially vulnerable subjects, however, we must craft new protections carefully. Prudence is required in shaping and implementing any new protections. (shrink)

The ethics of involving persons with cognitive impairments and/or mental illness in research continues to gain academic and public attention. Concerns about the ability of such persons to provide ethically and legally valid consent and about the appropriateness of their research involvement in certain categories of studies have resulted in publication of guidelines, position papers, standards, and court decisions. These analyses address not only when and from whom informed consent may be obtained but also under what conditions it is ethically (...) permissible to involve persons in research who are too decisionally impaired to provide their own consent.It is an advance in research ethics that there is heightened appreciation of the need for greater protections for, and possibly research participation limitations on, persons unable to give their own consent. In our zeal to protect potentially vulnerable subjects, however, we must craft new protections carefully. Prudence is required in shaping and implementing any new protections. (shrink)

Despite substantial research on overall decision-making capacity levels in schizophrenia, the factors that cause individuals to make errors when making decisions regarding research participation or treatment are relatively unknown. We examined the responses of 84 individuals, middle-aged or older, with schizophrenia or schizoaffective disorder. We used a structured decision-making capacity measure, the MacArthur Competence Assessment Tool for Clinical Research, to determine the frequency and apparent cause of participants’ errors. We found that most errors were due to difficulty recalling the disclosed (...) information, particularly the study’s procedures, potential risks, and purpose. Errors attributable to concrete thinking, psychotic symptoms, or perceived coercion were rarer. These results suggest that informed consent procedures for this population might be improved by providing information in a way that facilitates learning and memory, such as iterative disclosure of the information, corrective feedback, and emphasis of key points of the study—for instance, its purpose, procedures, and potential risks. (shrink)

This paper explores and rehabilitates the value of decisional privacy as a conceptual tool, complementary to informational privacy, for critiquing personalized choice architectures employed by self-tracking technologies. Self-tracking technologies are promoted and used as a means to self-improvement. Based on large aggregates of personal data and the data of other users, self-tracking technologies offer personalized feedback that nudges the user into behavioral change. The real-time personalization of choice architectures requires continuous surveillance and is a very powerful technology, recently coined (...) as “hypernudging.” While users celebrate the increased personalization of their coaching devices, “hypernudging” technologies raise concerns about manipulation. This paper addresses that intuition by claiming that decisional privacy is at stake. It thus counters the trend to solely focus on informational privacy when evaluating information and communication technologies. It proposes that decisional privacy and informational privacy are often part of a mutually reinforcing dynamic. Hypernudging is used as a key example to illustrate that the two dimensions should not be treated separately. Hypernudging self-tracking technologies compromise autonomy because they violate informational and decisional privacy. In order to effectively judge whether technologies that use hypernudges empower users, we need both privacy dimensions as conceptual tools. (shrink)

With the waves of reform occurring in mental health legislation in England and other jurisdictions, mental capacity is set to become a key medico-legal concept. The concept is central to the law of informed consent and is closely aligned to the philosophical concept of autonomy. It is also closely related to mental disorder. This paper explores the interdisciplinary terrain where mental capacity is located. Our aim is to identify core dilemmas and to suggest pathways for future interdisciplinary research. The terrain (...) can be separated into three types of discussion: philosophical, legal and psychiatric. Each discussion approaches mental capacity and judgmental autonomy from a different perspective yet each discussion struggles over two key dilemmas: whether mental capacity and autonomy is/should be a moral or a psychological notion and whether rationality is the key constitutive factor. We suggest that further theoretical work will have to be interdisciplinary and that this work offers an opportunity for the law to enrich its interpretation of mental capacity, for psychiatry to clarify the normative elements latent in its concepts and for philosophy to advance understanding of autonomy through the study of decisional dysfunction. The new pressures on medical and legal practice to be more explicit about mental capacity make this work a priority. (shrink)

El objetivo de este artículo es analizar las aportaciones que los avances en neuroética tienen en la toma de decisiones en las empresas. Empezaremos por cuestionar el paradigma dominante de la toma de decisiones empresariales desde el análisis crítico de los presupuestos epistemológicos de la teoría económica liberal, así como desde las perspectivas de las ciencias cognitivas y sus aportaciones al análisis del comportamiento humano. Continuaremos presentando dos grandes modelos de toma de decisiones éticas que se basan en la creación (...) de sentido intuitivo y que tienen sus fundamentos en los avances de las neurociencias. Concluiremos con breves observaciones críticas. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Appreciating Anorexia:Decisional Capacity and the Role of ValuesThomas Grisso (bio) and Paul S. Appelbaum (bio)Keywordscompetence, consent, anorexia, appreciation, decision makingTan and her colleagues (2006) reported that persons with anorexia nervosa typically manifest no difficulty satisfying the criteria for abilities associated with competence to consent to or refuse treatment. Their results led them to conclude that these patients generally had no problem grasping the nature of anorexia and its (...) possible consequences (understanding), typically did not have difficulty processing information when making treatment decisions (reasoning), and usually neither denied that they had a disorder nor manifested distorted beliefs about the potential consequences of treatment for the disorder.Nevertheless, these authors found, some anorexia patients said that they knew they might die and that they would rather die than suffer the alternative consequences (e.g., loss of identity, feeling of being disgusting). They point out that these beliefs, suggesting questionable competence, were not identified by the usual criteria for competence to consent to treatment. Therefore, they propose that we should consider a modification of the criteria for competence to consent to treatment. They argue for inclusion of "pathological values" as the basis for a finding of incompetence. Their notion of a pathological value (as we summarize it based on their Discussion) includes (a) a personal value (b) on which treatment refusal is based, that (c) is not authentic, and (d) is due to a mental disorder.Second, Tan and colleagues were concerned that the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), currently used widely to assess competence to consent to treatment, did not seem to take values into account when examining deficits related to lack of appreciation or reasoning. They point out that most patients with anorexia nervosa in their study had "pathological values" that influenced their thinking about treatment, yet they did not obtain poor scores on the instrument's appreciation scale, which assesses whether patients deny that they have the illness or offer reasons for accepting or refusing treatment that are based on delusional premises or a serious distortion of reality. Moreover, almost all of the anorexia patients in the study obtained adequate scores on reasoning, which examines the ability to process options and consequences when weighing a treatment decision. [End Page 293]Reasons for Caution in Altering Criteria for CompetenceA fundamental step in considering Tan and her co-worker's proposal is to examine whether it is necessary to add a concept of "pathological values" to the legal construct of competence to consent to treatment. Modifying the legal doctrine of consent is important if that is needed to improve its validity or reliability. But modifications of the doctrine would have considerable costs, including a long process of producing logical and empirical evidence for its necessity, developing methods to assess the new concept, and then a process of debate, persuasion, and education to change laws, ethical guidelines, and medical training. Moreover, principles of theory building urge parsimony. A theory should employ no more concepts or assumptions than are required to account for the phenomena that the theory seeks to organize or explain. So one must be sure that modifications are truly necessary before adding complexity to the theory of decisional competence.In addition, there is an inherent danger in altering a concept like competence to consent to treatment on the basis of the study of any one mental disorder. It is not at all clear how the modification might influence findings of competence when applied to other disorders. Using a study of patients with anorexia nervosa as the impetus for changing the competence concept runs this risk. For example, anorexia is one of a class of mental disorders that is characterized by a failure to abstain from behavior (here, limiting food intake and other behaviors designed to reduce weight) that has negative consequences for the person. Other conditions in this category might include substance abuse disorders and impulse control disorders (e.g., pathological gambling). Even if one concludes that revised criteria for competence would reduce false-positive findings of competence in this group of disorders, one would have to consider carefully its impact on the full range of disabling mental conditions.Moreover, the sensitivity... (shrink)

Volume 20, Issue 2, February 2020, Page 51-53.

En este artículo se analiza la teoría para la toma de decisiones y se contrasta la valía de los dilemas morales para explicar los mecanismos deliberativos. Se sostiene que una estrategia de decisión exitosa es aquella que es capaz de realizar los movimientos racionales, adaptativos y necesarios para llegar a un fin programado. Una aspiración de las éticas normativas y descriptivas es elaborar una teoría de la decisión práctica, sin importar los análisis racionales del modo en que se llegue al (...) fin. El artículo plantea los procesos relacionados al cambio y a la retroalimentación sin encasillar la teoría de las decisiones en posturas deontológicas, utilitaristas o emocionales. Se examina la valía de los dilemas morales y algunas críticas recurrentes y se concluye que, personales o impersonales, los dilemas parecen no explicar la complejidad de los procesos deliberativos. This article analyzes the theory for decision making and contrasts the value of moral dilemmas to explain the deliberative mechanisms. It is argued that a successful decision strategy is one that is capable of performing the rational, adaptive and necessary movements to reach a programmed end. It suggests that the processes related to change and feedback can be useful but insufficient explanations if the theory of decisions is framed to deontological, utilitarian or emotional postures. The value of moral dilemmas and some recurrent criticisms are examined and it is concluded that, personal or impersonal, the dilemmas do not seem to explain the complexity of the deliberative processes. (shrink)

In the long run, changes in society, both local and global, are inevitable. What, then, is and should be the relation between a general theory of law and social change? In the 1995 Kobe Lecture in Japan, Josef Raz said, “By and large, only bad theory can lead to change.” But a ‘good theory’, intended only to describe the normative world and not directly to change it or society, enlightens us in a way that changes our outlook in one way (...) or another. As our picture of the world changes, to that extent the change will be reflected in our practice. The change in practice in turn will affect society bringing about its change in the long run. That change can be either what was intended by the theory or an unintended consequence of it, sometimes favorable and sometimes disastrous. A theory may change the course of things as well by putting a halt to change. But if we can tell in advance that the theory will not lead to any social change whatsoever, it only means that the theory is trivial, or valueless even as a description. (shrink)

En este trabajo se defiende la existencia de un lugar específico para las decisiones de política educativa. Las decisiones de política educativa se presentan como un tipo de decisión ubicado entre la decisión técnica y la decisión moral. La racionalidad política, situada entre la racionalidad moral y la racionalidad científico-tecnológica, tiene una especial relevancia en el ámbito de la educación. Las decisiones de política educativa que no se confunden con la teoría interpretativa denominada Política de la Educación, ni con la (...) teoría práctica denominada Política Pedagógica, usan el conocimiento de la educación. En el trabajo se analiza con detenimiento la posibilidad de los hechos y las decisiones pedagógicas. El carácter axiológico de los hechos hace posible hablar de la orientación de la acción con fundamento en el conocimiento del propio proceso. Se mantiene que la decisión técnica es específica de la Pedagogía y su techo superior es el ámbito de la decisión moral. A su vez, las decisiones de política educativa se estudian en su especificidad y se concluye que los dos grandes errores en la polémica "ciencia-moral-política" son el reduccionismo del proceso al ciencismo o la subsunción de toda decisión en la decisión moral. El trabajo concluye que las peculiaridades de la decisión de política educativa, obligan a considerar que las finalidades no son criterios de decisión externos al sistema, sino constantes aceptadas provisionalmente en los procesos de planificación. Esta posición va más allá del esquema causal medios-fines y de la concepción taylorista de la organización, para defender frente a las largas cadenas de derivación de fines la formación de subsistemas de toma de decisiones. /// This article is engaged in upholding the appropiate place for decisions in Educational Politics and Policy. All that inside the knowledge of Education. Political decision making in the educational arena has got a place between technical decisions and moral decisions. That one has increasedy its relevance in educational forum. On the other point of view, this kind of decision must mot be understood as a result of the discipline "Politics of Education" or as a consequence of practical theories which are known like "Politica Pedag6gica" (Pedagogy into Politics). Decisions in educational policy are applied knowledge of Education but they are not made only with pedagogical facts and technical decisions. It's posible to think of technical decisions as the ones which come not only from the process, but from the knowledge of the process in its own. Pedagogy as a discipline of education let you make technical decisions. Upper these ones, we find the moral decision. To study the special characteristics of political decisions shows two bigs mistakes into the controversy "Science-Moral-Politics": scientism and moral subsunction of Political decision in that. In the last pages, this work goes beyond the causal relation between "means-ends". The authors suggest, for the field of goals, to make subsystem levels for decision making, in stead of using the taylorist model in order to organize several stages of goals. (shrink)

Informed consent represents a specific protocol for obtaining consent from a fully informed human subject to take part in clinical research. Still, informed consent is not only required for clinical trials but it also represents a critical precondition before enrolment in standard everyday medical procedures. Relevant fundamental criteria for obtaining informed consent must be followed, and that is that patient must have the decisional capacity to reach autonomous decision. The patient must be adequately informed and not coerced. Evaluating (...) class='Hi'>decisional capacity is crucial to providing the required level of care. The decision of which decisional capacity tool to use can be challenging because of various dissimilarities among the instruments. In this paper, four widely documented instruments have been evaluated, namely, the MacArthur Competence Assessment Tool for Treatment (MacCAT-T), the Hopkins Competency Assessment Test (HCAT), the Structured Interview for Competency/Incompetency Assessment Testing, Ranking Inventory (SICIATRI), and the Capacity Assessment Tool (CAT). Some of them include a fully structured interview; semi-structured forms characterise others. Most of them are adaptable for different scenarios, and yet, some are tailored for specific treatment decisions. Some evaluate all four components of decisional capacity, while others do not. Although a broad range of capacity assessment tools is available, it has been shown that they notably improve the accuracy of capacity evaluations. Given that many pathological conditions could result in impaired decisional capacity, physicians must be able to correctly and consistently assess the capacity for which education and previous experience are pivotal. (shrink)

Philosophy has much to offer psychiatry, not least regarding ethical issues, but also issues regarding the mind, identity, values, and volition. This has become only more important as we have witnessed the growth and power of the pharmaceutical industry, accompanied by developments in the neurosciences.

El presente artículo es una reflexión profunda sobre los principales fundamentos del Derecho penal. En concreto, se ocupa de esclarecer los criterios de verdad sobre los que se apoyan las decisiones de los jueces. Ello supone cuestionar las bases filosóficas y científicas más rígidas del mundo jurídico, que postulan su carácter objetivo, y exponerlas a la crítica sociológica y política.The present article is a deep reflection on the principal foundations of the Criminal law. Specially, it is busy with clarifying the (...) criteria of truth on those who rest the decisions of the judges. It supposes questioning the most rigid philosophical and scientific bases of the juridical world, which postulate his objective character, and exposing them to the sociological and political critique. (shrink)

Although treating the elderly occasion the same kinds of ethical issues as treating other patients, specific problems do arise when making decisions for persons, once competent, who no longer can express their values. I examine the problem of decisional incapacity and offer a critique of the principles, such as substituted judgment, and the instruments, such as advance directives, living wills, other instructional directives, as well as surrogate decision-makers.

Much attention has been given to determining whether an adolescent patient has the capacity to consent to research. This study explores the factors that influence adolescents' decisions to participate in a research study about youth violence and to determine positive or negative feelings elicited by being a research subject. The majority of subjects perceived their decision to participate to be free of coercion, and few felt badly about having participated. However, adolescents who were alone in the room during the assent (...) process were more likely to report that they chose freely to be a research subject. This study may influence the ways physicians communicate with adolescent patients around research assent within a clinical care environment. 1This article was presented at the Annual Meetings of The Pediatric Academic Societies in Baltimore, MD and The Society for Academic Emergency Medicine in Atlanta, GA in May, 2001. (shrink)

When should you say no? How do good choices make us happy? Read this book to learn about the choices and decisions people have to make every day.

Limits to paternalism are, in the liberal democracies, partially defined by the concepts of decision-making capacity/incapacity (mental competence/incompetence). The paper is a response to Ian Wilkss (1997) recent attempt to defend the idea that the standards for decisional capacity ought to vary with the degree of risk incurred by certain choices. Wilkss defense is based on a direct appeal to the logical features of examples and analogies, thus attempting to by-pass earlier criticisms (e.g., Culver Gert, 1990) of risk-based standards. (...) Wilkss argument is found wanting on the grounds that he misconstrues the logic of such capacity, especially in accounting for conceptual and pragmatic ties with issues of decisional authority. A diagnosis is offered as to the source of Wilkss error (the assumption that mental competence is a species of wider genus of competence), and an alternative way of accounting for risk within the predominant contemporary legal framework is sketched. (shrink)