Genuine of the medical field. Through this

physicians wanted to defend their patients from certain dangers by constructing
a code of ethics. Through this they developed The Hippocratic Oath, which outlined
a way of beginning to introduce medicine as a profession that everyday people
could trust. The completed this while providing a way to differentiate trained
physicians from other medical professionals. The information located inside The
Oath could confuse the modern reader as outdated, or perhaps inaccurate. The
Oath encloses certain bans of practices including abortion and not engaging in
surgery, which are included in today’s medical ethics. However, if we put these
exclusions in historical context, they make sense. In Hippocrates’ time,
abortion and surgeries would unquestionably jeopardize the lives of their
patients.  The aim was to forbid these practices which allowed physicians
putting their patients through unnecessary harm. The Hippocratic Oath is a
model code of professional medical ethics.  Unlike many modern
professional codes, its intent was to describe the “vision” for members of the
medical field. Through this a positive code of ethics was established, as it
describes what physicians are suppose
to do, but also what they are
not suppose to do. The two bans mentioned above seem to work
against this aim. The obvious reason for these bans is that physicians are
supposed to help their patients, not hurt them. The Hippocratic Oath arranges a picture-perfect position outline
to the model code of professional ethics, while demonstrating the precise direction
for entering this profession. 

            From early times, physicians have noticed
that the health and well-being of patients depends on cooperative effort
between both patient and physician. Patients distribute problems with physicians
for their own health care. The patient-physician relationship is the highest
benefit to patients when they bring medical problems to the attention to their
physicians in a timely fashion, with providing information about their medical
condition, and working with their physicians through a respectful alliance.

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Physicians can best contribute to this alliance by serving as their patients’
advocate.  This is completed through a
few rights: 1. The patient has the right to receive information from physicians
about their condition, including both diagnosis and prognosis. Patients should
receive guidance from their physicians as to the optimal course of action. 2. The
patient has the right to make decisions regarding his own healthy are. Also,
patients may accept or refuse any recommended medical treatment. 3. The patient
has the right to courtesy, respect, and timely attention to their needs. 4. The
patient has the right to confidentiality. However, the physician should not
reveal anything confidential without the consent of the patient. 5. The patient
had the right to continuity of health care. 6. The patient has a basic right to
have available adequate health care. Fulfillment of this right is dependent on
society providing resources so that no patient is left without necessary care due
to an inability to pay.

            In law the word
‘competence’ fulfils a well-defined role. This means that healthy adults have
full competence and are therefore capable deciding on their own. An example of
this is children gain full competence when reaching the “age of majority” which
is when minors are recognized by law as adults. The competence allows them to
complete decisions concerning not only health issues, but also all other
spheres of life.

previously mentioned the legal capacity is based on presumptions. The law
determines prima facie who has legal capacity and who lacks
legal capacity. Law puts limitations on certain classes of persons and
specifies whether they have full, limited or no capacity at all. Adults have in
principle full legal capacity, while children traditionally have limited legal
capacity. However, adults too can loose their legal capacity due to for example
a mental illness or alcoholic disease. This second group of individuals without
full legal capacity is called the incapacitated adults. A competent authority
will make the decision to in full or in part incapacitate the adult and hence
have no or limited legal capacity to take decisions about their health
care. In a number of cases adults with full legal capacity may
nevertheless also not be competent to consent, namely when a psychological
assessment of their decision-making capacity is needed.  The capacity to consent, judged from a medical point of view,
covers a set of abilities that enable a person to take health related decisions
independently. There is no fixed set of abilities, which prove decisional
capacity or their lack, but scholars agree on a set that should be met.

            What we know
as the standard of competence, is defined as a patient that is adequate to
making a treatment choice when they are at suitable capacity to understand, is necessarily
able to reason and deliberate, while occupying interests and concerns relevant
to the decision the patient is to make, and is able to speak about the decision
they arrive at (Buchanan & Brock, 1989). However, inside this outline,
three kinds of conception of competence have been prominent.  According to the first approach, there is a
defined bottom degree of ability to understand, deliberate, etc. exactly what a
patient needs to have in order to be able to make a knowledgeable treatment
decision (Buchanan & Brock, 1989). Secondly, competence is relative to the
outcome of the patient’s decision making procedure. An example includes, maintaining
a patients’ competent when they are able to make the rational treatment choice
themselves. The key point of the third account of competence is that competence
is relative to the risk the decision faced involves; low risk decisions
presuppose less ability to understand, deliberate, etc. than high risk
decisions do (Buchanan & Brock, 1989). Accordingly, this has been known as
the risk related conception of competence. Most versions of these three
approaches to understanding competence entail that the degree of decision making
ability competence assumes that it varies from one type of decision to another.

But when the question is about making the same type of decision, they would not
appear to allow that the degree of decision-making ability competent decision making
requires can vary from one person to another. In practice, competence
assessment is often initiated only when a patient is willing to make a
treatment choice that differs from the decision her healthcare providers would
make in their case.

above considerations suggest that the notion of competence should be defined in
terms of the autonomous values and concerns of the individual patient whose
competence is being assessed. In other words, what features of their situation
and options a patient must be able to take into account in order to be able to
make a competent choice and how should be determined on the basis of what the
patient autonomously considers important.

and Buchanan go on arguing that competency should be understood as decision
relative. This means a patients’ competency should be understood to be relative
to an exact decision, so that a patient might be competent to making one
decision, while not competent to another. 
A proper question to ask, when evaluating a patient’s competency, it not
“Is this patient competent” instead “Is the patient competent to make this
exact decision”?  The authors defined
this view of competence by emphasizing that different decisions will make
different demands on a patient’s ability to communicate and understand, while
reasoning and deliberating the relevant components to being competent. Some
decisions, for example, are straightforward that even a patient with limited abilities
could competently make a decision; other decisions will involve a variety of
complex alternatives and significant evaluation of probabilities. Making
patients competent to make some decisions but the opposite for others.

            It might
now be objected that if a patient’s competence is assessed in terms of what their
close ones believe to be their autonomous values, we end up considering a
patient competent only if they decide in the way those others think she should
decide. Therefore, as it would make a patient’s competence dependent on what
others think they should do, the proposed approach to defining competence is
after all rather a hidden form of surrogate decision making than an account of
competence that can pay sufficient respect for patient autonomy. As in health
care practice competence assessments are not made by patients themselves,
whether a patient is deemed competent will depend on what others come to believe
about their decision-making ability. In that sense all medical competence
assessment is like surrogate decision-making whatever account of competence is
adopted. But that similarity to surrogate decision making does not mean that in
competence assessment others make patients’ treatment choices on their behalf.

Instead, the question is about evaluating patients’ ability to decide about
their own treatment by themselves. According to the approach proposed above, if
a patient is deemed competent, they are allowed to make their own treatment
choice in accordance with their own autonomous plan. As already explained
above, the account of competence proposed is greatly able to pay sufficient
respect for patient autonomy than are the conceptions of competence that involve
notions of relevance, rationality, risk, etc. that patients may autonomously
reject. If the result of competence assessment is that a patient is not
competent to decide about their treatment, resorting to an appropriate form of
surrogate decision making becomes necessary. But surrogate decision-making
methods are to be utilized only after a patient is deemed incompetent. Saying
that competence assessment should refer to a patient’s autonomous values is not
saying that competence assessment and surrogate decision-making are one and the
same thing.