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Doody's Review ServiceReviewer: Michael Joel Schrift, DO, MA (University of Illinois at Chicago College of Medicine)
Description: The rapidly aging population has given rise to a dramatic increase in those suffering from dementia. Dementia as manifested by multiple domains of cognitive impairment ultimately leads to diminishment in the ability to render decisions. Autonomy which has been central to the way we understand ourselves and structure our lives and society cannot be truly respected where it does not exist, and so the accurate determination of capacity to choose becomes a critical feature of clinical decision making. In liberal societies, there is no standard of the good and therefore "appropriate" behavior cannot be objective. Only the individual has the responsible role in the determination of which decisions are "appropriate," since there is no agreed upon conception of the good or a privileged conception of the good. Competence assessment can be viewed as the determination for the eligibility to assume decision making responsibility and for rendering value judgments. Although competence is essential, it is the legal minimal threshold for autonomy and the determination of competence should serve to identify that minimal capacity for autonomy. This informative new book provides readers with the European perspective regarding the ethical and legal aspects of competence assessment. Written and edited by experts in the field, this is a welcome addition to the field of bioethics.
Purpose: The purpose, according to the editor, is to provide a review and broad perspective of competence assessment to European clinicians. The editor notes that there is no agreement on the level of competence at which it is in the best interest of the person with dementia to have a guardian and receive legal protection from abuse and other mistreatment. This book is an attempt to address the heterogeneity of assessment of competence.
Audience: The target audience is European healthcare personnel, but clinicians anywhere would benefit from the informative discussions here.
Features: The first ten chapters focus on cognitive, neuroanatomical, medical, pharmacological, ethical, and legal factors that affect competence. Included are chapters on testamentary capacity, consent for research, and driving/piloting assessment. The remaining chapters summarize the practice of competence assessment in the various European countries. Each chapter ends with relevant and timely citations of the scientific literature. An index would have been helpful.
Assessment: This is an excellent new book focusing on the assessment of competence from the European perspective. It should be read by clinicians worldwide and should serve as a model for a similar book from an American perspective.