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Competence in chronic mental illness: the relevance of practical wisdom
  1. Guy A M Widdershoven1,
  2. Andrea Ruissen1,
  3. Anton J L M van Balkom2,
  4. Gerben Meynen3
  1. 1 Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
  2. 2 Department of Psychiatry, GGZ inGeest, Amsterdam, The Netherlands
  3. 3 Department of Law, Tilburg University, Tilburg, The Netherlands
  1. Correspondence to Andrea Ruissen, Department of Medical Humanities, VU University Medical Center, Vd Boechorststraat 7, Amsterdam 1081 BL, The Netherlands; ruissen{at}


The concept of competence is central to healthcare because informed consent can only be obtained from a competent patient. The standard approach to competence focuses on cognitive abilities. Several authors have challenged this approach by emphasising the role of emotions and values. Combining cognition, emotion and values, we suggest an approach which is based on the notion of practical wisdom. This focuses on knowledge and on determining what is important in a specific situation and finding a balance between various values, which are enacted in an individual's personal life. Our approach is illustrated by two cases of patients with obsessive–compulsive disorder.

  • Competence/incompetence
  • Capacity
  • Psychiatry
  • Clinical Ethics

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