Professional Documents
Culture Documents
Karla McCarthy
3/12/17
THE U + A DEFINITION OF COMPETENCY 2
The key difference between the traditional U + A definition of competency and Gert and
colleagues’ definition is that the latter approach considers competency as task specific. They
define competency as simply the ability to make a rational decision of a certain kind (Bryan,
Sanders, & Kaplan, 2016). For example, a client may be competent to drive herself to work
every day, but not to care for a small infant. While the pure U + A definition focuses solely on
the client’s ability to understand the information presented to them and appreciate that the
information applies to them in the situation, Gert and colleagues recognized the importance of
taking the final decision into consideration as well. In the case of Michele, for example, in
addition to analyzing the case facts to determine that she is competent, Gert and colleagues
would also analyze her final decision to see if it indeed promotes good and avoids harm, as any
rational decision should. Gert and colleagues also pointed out that one’s ability to make a
rational decision of a certain kind can be interfered with by cognitive, affective, and volitional
factors, whereas the U + A approach only recognizes cognitive factors as inhibiting (Bryan,
I prefer Gert and colleague’s definition because it takes into account important aspects of
the case that may usually be overlooked by the traditional U + A evaluation. By recognizing that
practitioners can analyze the features of a case and identify if there are any factors that could
have seriously interfered with the client’s ability to make that specific decision. If there are,
recognizing and addressing these factors will cause the case to be analyzed in a much more
nuanced way than the purely U + A approach would yield, and can possibly justify overriding a
that it yields decisions that are consistent with our moral intuition, and that it fully supports the
client’s self-determination (Bryan, Sanders, & Kaplan, 2016). On the other hand, the main
weakness of the U + A approach is that it sometimes allows people deemed competent to make
irrational decisions that are counterproductive and may harm the person in the long term with no
justifiable cause.
The strengths of Gert and colleagues’ U + A definition are that it addresses multiple key
factors that the practitioner should analyze when deeming someone competent, is task specific to
emphasize that individuals can be competent in some areas and incompetent in others, and
extracts more relevant features of the case than the purely U + A definition, such as the
implications that the client’s final decision has on whether or not he or she is competent to
complete that specific task. The weaknesses of Gert and colleagues’ approach is that because
everyone ranks harms and goods differently, a competent client may be considered incompetent
if a practitioners’ idea of benefit and harm contrasts greatly with the client’s. For example, if the
doctor in Michele’s case deemed her incompetent because he felt that it was irrational for her to
not consider extension of her life the most important good that needed to be promoted, her
I agree that Michele was competent to refuse treatment, and that it would be unjustifiable
to force her to undergo the new procedure. Because the treatment hasn’t been tested before, and
because it is so rigorous, there is no guarantee that it will extend Michele’s life. In fact, because
of the intensity of the treatment, it may shorten her life, or cause her final days to be miserable.
The case facts adequately demonstrate that she is competent enough to understand her diagnosis,
and to appreciate that the treatment could apply to her, but also competent enough to be able to
THE U + A DEFINITION OF COMPETENCY 4
make her own decision to die peacefully rather than taking a chance on an experimental
treatment that could very well make her situation worse for herself. Despite her age, she seems to
be competent enough to make this rational decision, especially considering that she likely
researched the treatment, as she has been doing throughout her diagnosis.
If the treatment had been tested and proven to be safe with a high rate of success and
Michele still refused treatment, it may have been justifiable to deem her incompetent and
override her decision. In the case that her health would rapidly deteriorate without the safe,
effective treatment, it would be useful to consult with Michele as to what her reasoning would be
for not receiving treatment. Before overriding her decision solely based on her decision, it may
be necessary to analyze more case facts that are relevant to the case.
It may be, as was mentioned in the case study, that she would rather let the disease take
its course to be with her parents in heaven, even with the option of a safe treatment. This
complicates the case, because personally, I don’t believe that clients’ decisions should be
overridden when they are strongly convinced that a certain position is correct because of their
religious beliefs, as long as they are not hurting anyone. However, in this case, it may be helpful
to talk with Michele and help her realize that she can still meet her parents in heaven, even if she
has to wait. If the treatment could safely extend her life and help her to become happy and
healthy again, the team’s social worker could incorporate her beliefs into their consultation. For
example, the social worker could point out that even if she does undergo the treatment, she could
still meet her parents in heaven at a later time; the safe treatment could even be God’s way of
giving her more time on Earth to fulfill a greater purpose before reuniting with her parents in the
heavenly realm. If she continues to have an irrational fear of undergoing necessary treatment, it
Reference:
Bryan, V., Sanders, S., & Kaplan, L. (2016). The helping professional’s guide to ethics: A new