b. Categories of Incompetence. A person who is incompetent has impaired
reasoning power. The individual lacks mental capacities, such as understanding,
reasoning, and emotional stability. Such individuals lack sufficient mental capacity to
appreciate the nature and consequences of their own decisions. There are a number of
subcategories of incompetence that reflect the underlying cause of incompetence, i.e.,
the mentally ill, the mentally retarded, those with brain function disorders, the
unconscious patient, and those adjudicated to be incompetent by a court for such
purposes as making a contract or will, standing trial, being a parent, or giving consent.
c. Competence in Other Areas Irrelevant. The patient's competence to make
other types of decisions (financial, business transactions, and so forth) is not relevant to
the issue of competence for medical consent purposes. A patient found incompetent for
other types of decision-making may still have the mental capacity to make health care
d. Mental Capacity. In day-to-day, bedside consent situations, it is the
physician who makes the determination as to the patient's mental capacity (decision-
making capability). Competence is assumed unless called into question by the
physician's determination of mental incapacity.
mental capacity: the ability to make decisions and weigh alternatives; a clinical
determination made by the physician.
Understand alternatives and the consequences of their own decisions.
May be in a mental institution. (A medically irrational decision leading
to death may be acceptable, if the above criteria are met.)
Adjudicated incompetent by a court.
Figure 1-21. What distinguishes a competent patient from an incompetent one is the
ability to understand alternatives and the consequences of one's own