Balancing autonomy with paternalism for psychiatric patients? Ambiguities in personal choice and adcance directivesments [sic].

Cultural attitudes towards mentally and physically challenged and handicapped fellow-humans have changed from culture to culture and from century to century. But all cultures seem to have visible or hidden recognition of the dignity and uniqueness and sometimes divine characteristics of the handicapped. From bodily and mentally challenged acrobats and artists in the Chinese Imperial Court and the residences of European feudals to the divination of certain psychiatric persons in Eastern and Western cultures to limited legal rights of self-determination for the incompetent in many contemorary democracies, there is a wide range of acceptance and refusal of the 'other' who is different to most of us. In this paper I will discuss more specifically some selected aspects of the genuine competence of those who have been declared legally incompetent in accordance with certain cultural preconceptions or neurological or psychiatric criteria for tests.