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The U + A Definition of Competency

Karla McCarthy

University of South Alabama


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,

Sanders, & Kaplan, 2016).

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

a decision made by a client is counterintuitive, using Gert and colleagues’ framework,

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

client’s self-determination in order to keep them safe.


The strengths of the purely U + A definition are that it is a straightforward evaluation,

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

decision could have been overridden for an unjustifiable reason.

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

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

will likely be justifiable to override her decision.



Bryan, V., Sanders, S., & Kaplan, L. (2016). The helping professional’s guide to ethics: A new

perspective. New York, NY: Oxford University Press.