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Some conferences produce proceedings, others an inspiration to labor, which finally leads to a published work. Such has been the case with regard to this volume. In 1984, the Center for Ethics, Medicine, and Public Issues held a conference with the title 'When are Competent Patients Incompetent?' with the support of the Texas Committee for the Humanities, a state-based program of the National Endowment for the Humanities. Assistance was provided by both Baylor College of Medicine and the Institute of Religion. This conference evoked a con siderable interest in examining further the moral status of competency determinations in the clinical setting. This interest is realized in this volume, which now affords us an opportunity to thank all those individ uals who made the conference possible, only some of whom are acknowledged in this Preface. In particular, we wish to express our gratitude to Baruch A. Brody, Rebecca Dresser, the Honorable Jerome Jones, H. Steven Moffic, Margery W. Shaw, Eleanor Tinsley, and Albert Van HeIden. The volume took its shape through the labors of Earl Shelp and Mary Ann Gardell Cutter, who inspired the further evolution of the papers presented at the conference and attracted contributions from individuals who had not attended. Earl Shelp and Mary Ann Gardell Cutter have produced a volume following extensive reflection and dialogue; they were ably assisted in the final preparation of the manu script by Thomas J. Bole III and George Khushf, to whom special thanks are due.

Competency: A Study of Informal Competency Determinations in Primary Care

I / The Clinical Context.- Judging Competence: When the Psychiatrist Need, or Need Not, Be Involved.- Informal Judgments of Competence and Incompetence.- II / Reexamining Concepts of Competence.- Competence.- Judgments of Incompetence and Their Moral Presuppositions.- III/Fashioning Law and Public Policy.- Competence: At the Intersection of Law, Medicine, and Philosophy.- The Geography of Competency.- Medical Treatment Decisions and Competency in the Eyes of the Law: A Brief Survey.- IV / Case Studies: Seeking Insight From Application.- Competency Judgments: Case Studies From the Internist's Perspective.- Competency Judgments: Case Studies from the Psychiatrist' Perspective.- Competency Judgments: Case Studies in Moral Perspective.- V / Commentary and Critique: Another Look at Concepts of Competence.- The Competency of Definitions of Competency.- Judgments About Patient Competence: Cultural and Economic Antecedents.- Patient Freedom and Competence in Health Care.- Breaking up the Shell Game of Consequentialism: Incompetence - Concept and Ethics.- Competency: A Triaxial Concept.- Notes On Contributors.