Mental Competence or Capacity to Form a Will: An Anthropological Approach1

Because of the concern for abuse of compulsory admission and involuntary treatment, the question of how to assess mental competence is a topic of ongoing debate. The literature seems to focus on empirical approaches, thereby overlooking the lack of conceptual clearness. This article describes an anthropological reflection on the concept of competence. Contrary to the current approach within medical ethics, this conceptualization of competence is based on positive autonomy. In this article, the question of mental competence is linked to the patient’s ability to respond to a given situation in coherence with what he values in life. Based on Frankfurt’s real self view to responsibility, this approach is further elaborated. The human capacity for self-reflection, including the power to act upon it, plays a crucial role in this view. If a patient lacks this capacity or if he otherwise fails to conform his (first-order) will to his deeper motives and values, his will does not seem to reflect his real self and he cannot be deemed fully responsible for it. As such, mental incompetence could be considered an impairment of one’s capacity for responsibility. In the interaction between the physician and the patient, more attention should be paid to fostering this capacity instead of the assessment thereof.