1. Competency to Give an Informed Consent: A Model for Making Clinical Assessments
James Drane

2. The Complexity & Importance of Consent
Autonomy
But, the appearance only of consent does not equal autonomy and may lead patients to ‘choose’ things that harm them.
Standards of competency involves law, ethics, and psychiatry.
Must ensure that competent patients are prohibited from choosing and that incompetent patients aren’t allowed to make decisions.

3. Models for Making Assessments
A variety depending on different medical conditions:
Acute vs. chronic
Critical vs. noncritical
3 different standards or definitions of what it means to be competent

4. Standard 1
Least stringent – applies to medical decisions that are not dangerous and objectively are in the patient’s best interests.
Awareness
Assent (a an objectively rational course of action).
Will apply to people who will not be able to give “full consent” to other types of treatment.

5. Standard 2
For situations where the illness is chronic (rather than acute)
Where the treatment is more dangerous
Where there are real alternative treatments
Understanding (as opposed to awareness) of various options and their risks-benefits is required.
This doers NOT require the ability to articulate conceptual or verbal understanding.
The patient can choose to let the physician make the decision.

6. Standard 3 Most stringent.
Occurs when: medical action decided upon is dangerous and opposes both professional and public rationality.
The available treatment is effective and not taking it is dangerous, perhaps life threatening.
The decision appears (at least) to be irrational.

7. Standard 3
Appreciation is required here where person understands the medical info + the nature and consequences of their alternate decision. The person must be able intelligently and coherently describe their reasons.