summary
background Informed consent, a central concept in the doctor-patient relationship, is only valid if it is given by a competent patient.
aim To review the literature on competence or decision-making capacity in psychiatry.
method We studied the international literature and relevant Dutch material such as health acts and medical guidelines.
results We found a consensus in the literature about the assessment criteria and the basic principles, but we did not find any consensus about the exact definition of competence. We review a number of perspectives on competence. The conceptualisations of competence, particularly in the field of psychiatry, are still being debated. The best known clinical tool to assess patients’ capacities to make treatment decisions is the MacArthur Competence Assessment Tool (Maccat).
conclusion There are three perspectives on competence: a cognitive perspective, a perspective concerning emotions and a perspective relating to values. Further research is needed in order to make the conceptual debate on competence relevant to psychiatric practice.