The Neuroscience of Decision Making and Our Standards for Assessing Competence to Consent
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ORIGINAL PAPER
The Neuroscience of Decision Making and Our Standards for Assessing Competence to Consent Steve Clarke
Received: 16 September 2011 / Accepted: 3 November 2011 # Springer Science+Business Media B.V. 2011
Abstract Rapid advances in neuroscience may enable us to identify the neural correlates of ordinary decision making. Such knowledge opens up the possibility of acquiring highly accurate information about people’s competence to consent to medical procedures and to participate in medical research. Currently we are unable to determine competence to consent with accuracy and we make a number of unrealistic practical assumptions to deal with our ignorance. Here I argue that if we are able to detect competence to consent and if we are able to develop a reliable neural test of competence to consent, then these assumptions will have to be rejected. I also consider and reject three lines of argument that might be developed by a defender of the status quo in order to protect our current practices regarding judgments of competence in the face of the availability of information about the neural correlates of ordinary human decision making. Keywords Competence . Decision making capacity . Informed consent . Neural correlates . Rule of thumb . Status quo
S. Clarke (*) Oxford Martin Institute and Faculty of Philosophy, University of Oxford, Oxford, UK e-mail: [email protected]
Competence to Provide Informed Consent In order to provide ethically and legally valid informed consent to undergo a medical procedure or to participate in medical research, a patient, or prospective research subject must be competent to do so [1]. Competence is a threshold concept. All of those who are judged to be competent to drive a car are judged to be able to drive a car at or above a certain level of ability, and are hence considered eligible to receive a driver’s licence. Those who fail to demonstrate an ability to meet this threshold of competence are generally considered ineligible to receive a driver’s licence. Although competence is a threshold concept it would be a mistake to suppose that there is an absolute threshold between competent and incompetent drivers out there in the world waiting to be discovered. There is a spectrum of different levels of driving ability and a society chooses where to set the threshold between competent and incompetent drivers on this spectrum. A society may choose to set the threshold between competent and incompetent drivers at a variety of different levels of driving ability depending on the goals that it wishes to promote. If we wish to promote safety we might choose to set the threshold at a high level, whereas if we wished to promote car ownership and use, and are willing to tolerate an increased number of accidents we may choose to set the
S. Clarke
threshold lower than we would otherwise.1 Possession of a driver’s licence is an indication of driving competence. It is an indication that licensed drivers are competent to drive in many circumstances, but it is not an indic
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