Knowing Well or Living Well

In many western cultures nowadays, the law requires that competent patients make their own decisions in healthcare. Incompetent patients need special protection and care, especially when it comes to medical research. In dealing with cognitively impaired, demented patients, however, clinical experience shows that these patients can still have moral capacity to make judgments about their lives, at least within certain boundaries. These cases show that the notion of competence contains socially accepted rules, variable among themselves in different situations. This variation excludes a priori acknowledgment of moral capacity, and hence a single instrument deemed to be conclusive about that capacity. The physician has to balance the rule of law with the moral interests of the patient. In our study, the notions of competence and moral capacity are researched from an empirical and a philosophical point of view. Both indicate that refinement of the legal concept of competency is necessary to assess the moral capacity of demented persons, while a reassessment of the concept of competence in relation to moral capacity should also be taken into account.