Competency to Decide for Another

Our topic is competency of a Substitute Decisionmaker (SubDM) to make a decision about medical treatment for another who is incompetent himself (the “ward”). While there is Competency to Decide for Another considerable literature on competency to decide for oneself, there is very little on competency to decide for another. Some studies look at a range of things that a SubDM needs to do —for example, seek information on what the ward has said—but there is none on how well a person must understand the relevant issues to be a competent SubDM

Symposium: Gender, Health and the Constitution: The Misalignment of Medical Capacity and Legal Competence for Perinatal People with Serious Mental Illness

This Article evaluates the misalignment of medical capacity and legal competence for perinatal people with serious medical illnesses (SMI), an issue that has had limited discourse in legal academia. It delineates the contours of these concepts, dissecting their theoretical underpinnings and practical applications. While medical capacity is often considered an iterative, context-specific determination, legal competence is typically treated as a rigid, binary legal categorization. It then illustrates how the disparate scope and aims of capacity and competence lead to a precarious misalignment for people with fluctuating mental states, particularly perinatal people with SMI. The Article proposes solutions to harmonize the medical and legal paradigms including normative considerations and practical policy changes, aiming to protect the rights and well-being of individuals while ensuring that determinations are fair, accurate, and reflective of an individual’s true abilities. Ultimately, the Article advocates for a paradigm shift away from the legal system’s inflexible, protectionist approach towards a more nuanced, adaptable capacity assessment model that responds to the variable nature of living with mental illness

Postsurgical morbidity and mortality favorably informs deep brain stimulation for new indications including schizophrenia and schizoaffective disorder

BackgroundDeep brain stimulation (DBS) shows promise for new indications like treatment-refractory schizophrenia in early clinical trials. In the first DBS clinical trial for treatment refractory schizophrenia, despite promising results in treating psychosis, one of the eight subjects experienced both a symptomatic hemorrhage and an infection requiring device removal. Now, ethical concerns about higher surgical risk in schizophrenia/schizoaffective disorder (SZ/SAD) are impacting clinical trial progress. However, insufficient cases preclude conclusions regarding DBS risk in SZ/SAD. Therefore, we directly compare adverse surgical outcomes for all surgical procedures between SZ/SAD and Parkinson's disease (PD) cases to infer relative surgical risk relevant to gauging DBS risks in subjects with SZ/SAD.DesignIn the primary analysis, we used browser-based statistical analysis software, TriNetX Live (trinetx.com TriNetX LLC, Cambridge, MA), for Measures of Association using the Z-test. Postsurgical morbidity and mortality after matching for ethnicity, over 39 risk factors, and 19 CPT 1003143 coded surgical procedures from over 35,000 electronic medical records, over 19 years, from 48 United States health care organizations (HCOs) through the TriNetX Research Network™. TriNetXis a global, federated, web-based health research network providing access and statistical analysis of aggregate counts of deidentified EMR data. Diagnoses were based on ICD-10 codes. In the final analysis, logistic regression was used to determine relative frequencies of outcomes among 21 diagnostic groups/cohorts being treated with or considered for DBS and 3 control cohorts.ResultsPostsurgical mortality was 1.01–4.11% lower in SZ/SAD compared to the matched PD cohort at 1 month and 1 year after any surgery, while morbidity was 1.91–2.73% higher and associated with postsurgical noncompliance with medical treatment. Hemorrhages and infections were not increased. Across the 21 cohorts compared, PD and SZ/SAD were among eight cohorts with fewer surgeries, nine cohorts with higher postsurgical morbidity, and fifteen cohorts within the control-group range for 1-month postsurgical mortality.ConclusionsGiven that the subjects with SZ or SAD, along with most other diagnostic groups examined, had lower postsurgical mortality than PD subjects, it is reasonable to apply existing ethical and clinical guidelines to identify appropriate surgical candidates for inclusion of these patient populations in DBS clinical trials

Aristotle's account of sense-perception in De Anima II.5, II.12, and III.2

The idea that Aristotle portrays perception as a kind of conceptual activity is supported by this thesis. This support is the result of a detailed consideration of Aristotle's formal characterizations of perception in De Anima II.5, II.12, and III.2. The first chapter considers Aristotle's doctrine that actual sense and sense-object are 'the same, but different in being' (DA III.2). This doctrine may amount to the dispositional view that sense-qualities as sensed exist only when sensed, or to the trivial view that sensed sense-qualities so exist. Aristotle's treatment of his non-Democritean predecessors, and his positive account of the sense-qualities in DA and DS, cannot decide between these interpretations. His rejection of the Democritean dispositional theory on the basis of features shared by all dispositional theories, however, would seem to confirm the trivial interpretation of the unity-of-actuality doctrine. The second chapter turns to Aristotle‘s doctrine that perception is a special kind of assimilation of the senser to the object of sense (DA 11.5). A change in the senser's sense-organs is unlikely~fo be a case of the special kind of assimilation, whose distinctive feature is its status as an energeia. The senser's cognitive assimilation to the oBgect of sense, on the other hand, might well be. The view that Aristotle's assimilation doctrine identifies such an assimilation, however, requires support from Aristotle‘s form-without-matter doctrine. The doctrine that sense receives the sensible forms without the matter (DA 11.12) is thus the subject of the third chapter. Physicalist and unity-of-actuality interpretations of this doctrine, antecedently implausible, are in fact unsatisfactory. An acceptable non-physicalist interpretation, however, may be based on the view that a form-without-matter is a universal. On this interpretation, Aristotle's form-without-matter doctrine (supplemented by his assimilation doctrine) states that perception is the reception of a particular sensible as a sensible. If this interpretation is right, Aristotle would indeed see perception as a kind of conceptual activity.</p

Competency to Decide for Another

Our topic is competency of a Substitute Decisionmaker (SubDM) to make a decision about medical treatment for another who is incompetent himself (the “ward”). While there is Competency to Decide for Another considerable literature on competency to decide for oneself, there is very little on competency to decide for another. Some studies look at a range of things that a SubDM needs to do —for example, seek information on what the ward has said—but there is none on how well a person must understand the relevant issues to be a competent SubDM

Aristotle's account of sense-perception in De Anima II.5, II.12, and III.2

The idea that Aristotle portrays perception as a kind of conceptual activity is supported by this thesis. This support is the result of a detailed consideration of Aristotle's formal characterizations of perception in De Anima II.5, II.12, and III.2. The first chapter considers Aristotle's doctrine that actual sense and sense-object are 'the same, but different in being' (DA III.2). This doctrine may amount to the dispositional view that sense-qualities as sensed exist only when sensed, or to the trivial view that sensed sense-qualities so exist. Aristotle's treatment of his non-Democritean predecessors, and his positive account of the sense-qualities in DA and DS, cannot decide between these interpretations. His rejection of the Democritean dispositional theory on the basis of features shared by all dispositional theories, however, would seem to confirm the trivial interpretation of the unity-of-actuality doctrine. The second chapter turns to Aristotle‘s doctrine that perception is a special kind of assimilation of the senser to the object of sense (DA 11.5). A change in the senser's sense-organs is unlikely~fo be a case of the special kind of assimilation, whose distinctive feature is its status as an energeia. The senser's cognitive assimilation to the oBgect of sense, on the other hand, might well be. The view that Aristotle's assimilation doctrine identifies such an assimilation, however, requires support from Aristotle‘s form-without-matter doctrine. The doctrine that sense receives the sensible forms without the matter (DA 11.12) is thus the subject of the third chapter. Physicalist and unity-of-actuality interpretations of this doctrine, antecedently implausible, are in fact unsatisfactory. An acceptable non-physicalist interpretation, however, may be based on the view that a form-without-matter is a universal. On this interpretation, Aristotle's form-without-matter doctrine (supplemented by his assimilation doctrine) states that perception is the reception of a particular sensible as a sensible. If this interpretation is right, Aristotle would indeed see perception as a kind of conceptual activity