Academic journal article The Hastings Center Report

Mary and Jane

Academic journal article The Hastings Center Report

Mary and Jane

Article excerpt

Both of the feature articles in this issue ask about how comprehension intersects with the rights and responsibilities of decision-makers. Both also begin with puzzling cases.

In the lead article, Adrienne Martin draws upon Tom Beauchamp and James Childress's work to give us "Ray," a man who mutilates himself because of his "unusual religious beliefs," and "Mary," who believes that God will make a statistically less successful treatment option successful for her. Martin asks whether Ray and Mary have the ability to make their own health care decisions--an ability usually called competence. In some ways they look competent: they are apparently able to reason clearly, for example. In other ways they seem to lack competence: their conclusions--indeed their premises--are at odds with a correct medical, scientific understanding of their medical problems and treatment. At least from a medical, scientific standpoint, they do not adequately understand their situation.

Martin's recommendation is that we distinguish competence from rational decision-making capacity. To possess a rational decision-making capacity, you have to understand your health problems and treatment options. Because Ray and Mary lack that understanding, they lack decision-making capacity--at least, they lack it in the context of the particular health care decisions at issue. But they do not necessarily lack competence, for other considerations may impel us to accord Ray and Mary the status of being able to make their own health care decisions. In effect, "the ability to make health care decisions" is twofold in Martin's analysis and cannot all be squished under the one heading of competence. …

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