Constructing competence: formulating standards of legal competence to make medical decisions.

A young woman twenty-six weeks pregnant and dying from cancer lies heavily sedated and attached to a respirator. Is she competent to determine what life-prolonging measures should be taken, or to consent to an emergency cesarean section that may save her fetus but will probably shorten her life? A quadriplegic young man wishes to end his life and requests a court order granting immunity for the medical staff who will unhook his respirator and administer sedatives. Is he competent to choose to die? A delusional man wanders into a psychiatric hospital and believes he is entering heaven rather than a hospital. Is he "too crazy" to admit himself voluntarily? As these cases indicate, questions of decisionmaking com-