Report No. 196

(1) Competent and incompetent patients

It is first necessary to define 'incompetent patients'.

An 'incompetent patient' is (i) a minor or person of unsound mind or (ii) a patient who is unable, on account of pain or suffering (physical, mental or psychological) to

(a) understand the information relevant to an informed decision about him or his medical treatment,

(b) retain that information,

(c) use or weigh that information as part of the process of such decision or

(d) to treat an informed decision because of the impairment of or a disturbance in the functioning of his mind or brain

(e) to communicate his or her informed decision (whether by speech, sign language or any other method).

In such cases, the decision will be of the medical practitioner to decide to withhold or withdraw medical treatment, if that was in the best interests of the patient.

A patient who is not an 'incompetent patient' is a 'competent patient'.

As stated earlier, in the case of a terminally ill patient who is competent, if he refuses treatment, it is binding on the doctors unless the doctors are of the view that the patient's decision is not an informed decision. If a competent patient requires medical treatment be continued, it is not permissible for the doctor to stop or refuse medical treatment.

Such a question also arises in the case of all incompetent patients as well as competent patients whose decision, to refuse medical treatment is not an informed decision.

That is why it is necessary to define who is an 'incompetent person' first and define, in a negative way, who is a 'competent person'.