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Andrea Ruissen, Guy Widdershoven, Anton van Balkom, and Gerben Meynen consider two cases of obsessive–compulsive disorder and the judgements of (in)competence licensed by four approaches: the MacCAT-assisted assessment and the cognitive, emotions, and values approaches.1 They conclude by outlining an alternative approach to competence which appeals to Aristotle's notion of practical wisdom (phronēsis).
For reasons of space, I focus only on Ruissen and colleagues' case of Jack. He retrospectively claims that he was incompetent at the time of his original admission, and this is something his psychiatrist (also retrospectively) agrees on. Ruissen et al. argue that the four approaches they consider either license a judgement of competence or do not give us reason to doubt competence. Their preferred practical wisdom approach licenses a judgement of incompetence, in line with both Jack and his psychiatrist. Now considering discontinuing treatment, Jack claims he is competent, and again, according to Ruissen et al., the four approaches they consider either agree or do not give us a reason to doubt this judgement. Jack's psychiatrist suspects incompetence, and this is a judgement also licensed by Ruissen and colleagues’ practical wisdom account.
Approaches to competence are discussed with reference to the patient's and psychiatrist's judgements of competence, and it is implied that approaches earn a theoretical point if they are …