c. If the Physician Has Doubts. If the physician has doubts as to the patient's
mental capacity, a consultation from another physician with the appropriate expertise
should be obtained. It should be someone who is not treating the patient. If, for
example, the physician suspects mental retardation, mental illness, or disorders that
affect brain function, he or she can consult a psychiatrist or other appropriate
specialists. If drugs or infection clouds the patient's judgment, an attempt should be
made to remove the impediment to decision making. Such a patient is not considered
incompetent, rather judgment is considered to be temporarily impaired.
TEMPORARY JUDGMENT-IMPAIRING CONDITIONS
Unfamiliar hospital setting.
Absence of supportive family.
Anticipation of surgery.
PHYSICAL CONDITIONS ASSOCIATED WITH ALTERED MENTAL STATES.
Figure 1-20. If a temporary judgment-impairing condition exists and the patient's
condition is not life-threatening, the physician must wait until the
temporary condition is overcome before seeking the patient's consent
1-24. INCOMPETENT ADULTS
a. A Legal Determination. Based on the physician's determination of mental
incapacity, the judge will determine whether or not the patient is competent to give
consent. The degree of understanding required in order for a patient to be declared
competent will depend on the nature of the procedure to be performed, and the level of
consent needed. As stated earlier, there are no clear guidelines defining competence
apart from the ability to weigh alternatives. The determination of competence will
ultimately depend on what satisfies the judge. (A person who is incapable of
understanding alternatives is considered incompetent.)
incompetent (for consent purposes): lacking the mental capacity to make
rational decisions or to conduct one's personal affairs; a legal determination.