To the Editor: In his Clinical Practice article on the assessmentof patients' competence to consent to treatment (Nov. 1 issue),1Appelbaum invokes the ability to reason as a central criterionfor capacity. I consider this ethically troublesome. The criterionthat can replace reasoning, with fewer unintended consequences,is consistency over time.2 Capacity has more to do with actingcharacteristically than with acting reasonably.
Appelbaum concludes, for the case presented, that "psychiatricconsultation should be considered" because of the possible presenceof early dementia or depression, despite acknowledging thatneither condition rules out capacity. Capacity is presumed forall adults, . . . [Full Text of this Article]
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