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The Neuroscience of Decision Making and Our Standards for Assessing Competence to Consent

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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.

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Notes

  1. However, if we set the threshold too low we might fail to promote car ownership and use as the resulting increased chance of being involved in a driving accident may deter people who are sufficiently risk averse from owning and using cars.

  2. In the UK this is very much a rule of thumb. The default age of consent is 16, however, a child under the age of 16 may be deemed to be competent to consent if they are judged to be mature enough to understand the nature and implications of undertaking a medical procedure. This is known as ‘Gillick competency.’ For more on Gillick competency see [13].

  3. Similar issues arise in legal contexts. It seems plausible to think that defendants who face multiple charges might have sufficient mental capacity to be competent to stand trial to some of these but not others. However, courts have generally been reluctant to allow for this possibility, on pragmatic grounds [16].

  4. In a recent paper Jotterand et al. deploy neuroscientific results to argue that competence to provide informed consent is impaired by treatment resistant depression [28].

  5. Farah et al. have recently argued that concerns about violations of brain privacy are realistic [29].

  6. While the norm of respect for patient confidentiality is generally upheld in medical practice more needs to be done before the same can be said about the norm of respect for research subject privacy in medical research [33].

  7. For discussion of status quo bias and other default biases see [34].

  8. For discussion of the prospects of future cognitive enhancement and related ethics and regulatory issues see [35].

  9. Thanks to an anonymous reviewer as well as audiences at the Philosophy Department, University of South Carolina, the Centre for Applied Philosophy and Public Ethics, Canberra Division, and the 10th World Congress of Bioethics, Singapore 2010 for helpful comments on earlier drafts of this paper.

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  1. Oxford Martin Institute and Faculty of Philosophy, University of Oxford, Oxford, UK

    Steve Clarke

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Clarke, S. The Neuroscience of Decision Making and Our Standards for Assessing Competence to Consent. Neuroethics 6, 189–196 (2013). https://doi.org/10.1007/s12152-011-9144-2

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