The Situated and Dialogical 'Nature' of (In)Competence: A Socio-Cultural Approach to Informed Consent Treatment Decision-Making Competence in Adults Diagnosed with Intellectual Disability.

详细信息   

• 作者：Greco-Joseph ; Lisa.
• 学历：Doctor
• 年：2013
• 导师：Glick,Joseph,eadvisorStetsenko,Annaecommittee memberChapin,Davidecommittee memberKatz Rothman,Barbaraecommittee memberDinerstein,Robertecommittee member
• 毕业院校：City University of New York
• Department：Psychology.
• ISBN：9781267930477
• CBH：3553560
• Country：USA
• 语种：English
• FileSize：4986397
• Pages：415

文摘

The Situated and Dialogical Nature of In)Competence: A Socio-Cultural Approach to Informed Consent Treatment Decision-Making Competence in Adults Diagnosed with Intellectual Disability Assessment of treatment decision-making competence emerges in situations where incompetence is suspected,for example in situations involving adults diagnosed with intellectual disability. Competence Judgments have traditionally been considered a matter of individual intellect. Alternatively,a developmental perspective based within a socio-cultural framework considers competence an interactional process and a matter of dialogical self-other encounters where information is exchanged and perspective taking where the point of view of the other is legitimized as being worthy of consideration. This qualtiative study examined reports of self-other encounters by adults diagnosed with intellectual disability placed in residential agencies and the employees of those agencies. Encompassing a variety of perspectives 44 individuals acros three non profit agencies within New York State participated. Interviews were used to elicit accounts of self-other encounters from 29 adults diagnosed with intellectual disability and 19 employees across a range of positions from direct-care to upper management. Findings revealed that accountability issues were particularly salient for employees with and across agencies tailoring policies,practices and type of encounters with the adults placed. Employee encounters with placed adults were characterized by monological relations； constraining access to necessary social knowledge and information required to demonstrate competence. Autonomy relating to treatment decisions hinged on employee and professionals judgment of placed adults as kinds of persons---competent or incompetent. Incompetence frequently emerged based on their placed status positioning them recipients of rather than agents for services and treatments. Accordingly,many placed adults perceived medical and mental health services and treatments as devoid of choice. Responses to a standardized capacity assessment instrument employing vignettes evidenced their knowledge of the distance between their actual experiences and ideal forms hypothetically constructed. Shifts in judgments allowing them greater autonomy occurred when they articulated legitimate forms of social knowledge in self-other encounters； often not predicted by IQ scores or assessment outcomes. Accessing these legitimate forms came from sources primarily outside of the agencies---through self-other encounters involving dialogical relations e.g. with pharmacists) or accessing tools self-appropriated through available technology e.g. Television commercials,computers). Including the perspective and knowledge of adults diagnosed with intellectual disability these findings demonstrate that from an agency point of view,in the context of accountability,incompetence is the default and safe position. Shifting this view rests on increasing inclusive practices---encouraging dialogical relations in self-other encounters between adults diagnosed with intellectual disability and the professionals providing services to them,through which knowledge and information is made accessible. Implications of these findings impact law and policy regarding competency evaluations,guardianship,and rights as these pertain to adults diagnosed with intellectual disability.