Competency and consent to treatment

To the Editor.— Professor Drane's article, "Competency to Give an Informed Consent: A Model for Making Clinical Assessments," 1 offers a notable attempt to simplify the process of obtaining informed consent for medical care. Unfortunately, his suggestion of a "sliding standard" for competency raises serious ethical questions that undermine the value of his scheme. Standard 1 is intended to apply to those situations where the medical procedure is "not dangerous and objectively in the patient's best interest." In such cases the least stringent test for competency holds. Informed consent is considereed to have been given "as long as the patient is aware of what is going on." Whenever the illness is chronic or the proposed treatment more dangerous, then standard 2 is in effect. In these circumstances, competency to give consent exists if the patient is able to understand the risks and outcomes and is able to choose an alternativ

Psychiatric Ethics: Entering the 1990s

Dr. Eth's introduction: In July 1984 the first Ethics column appeared in the pages of H&CP, signifying the general interest and importance of ethical issues to mental health professionals. Since then, 17 articles have addressed such diverse topics as prosecuting patients for assault and using methadone as a research treatment for schizophrenia. Now, in the final column of this series, I survey some of the issues that illustrate the evolving nature of the ethical analysis of value conflicts in psychiatry