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Decision-making capacity

Stanford Encyclopedia of Philosophy (2011)

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  1. Dementia and Concurrent Consent to Sexual Relations.Samuel Director - 2023 - Hastings Center Report 53 (3):37-45.
    Philosophers have become newly interested in the ethics of sex. One promising feature of this new discussion is that it has been broadening our moral lens to include individuals whose sexual interests have historically been denied or ignored. One such group is the elderly. Contrary to popular belief, many elderly people want to have sex and see it as a regular part of their lives. If society harbors ignorance about or prejudice against elderly sexuality, it harbors stronger views against the (...)
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  • Problems of Control: Alcohol Dependence, Anorexia Nervosa, and the Flexible Interpretation of Mental Incapacity Tests.Jillian Craigie & Ailsa Davies - 2018 - Medical Law Review 27 (2):215-241.
    This article investigates the ability of mental incapacity tests to account for problems of control, through a study of the approach to alcohol dependence and a comparison with the approach to anorexia nervosa, in England and Wales. The focus is on two areas of law where questions of legal and mental capacity arise for people who are alcohol dependent: decisions about treatment for alcohol dependence and diminished responsibility for a killing. The mental incapacity tests used in these legal contexts are (...)
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  • Utilitarianism, Altruism, and Consent.Meacham Christopher - 2022 - Journal of Ethics and Social Philosophy 21 (1).
    A number of criticisms of Utilitarianism – such as “nearest and dearest” objections, “demandingness” objections, and “altruistic” objections – arise because Utilitarianism doesn’t permit partially or wholly disregarding the utility of certain subjects. A number of authors, including Sider, Portmore and Vessel, have responded to these objections by suggesting we adopt “dual-maximizing” theories which provide a way to incorporate disregarding. And in response to “altruistic” objections in particular – objections noting that it seems permissible to make utility-decreasing sacrifices – these (...)
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  • Why Even a Liberal Can Justify Limited Paternalistic Intervention in Anorexia Nervosa.Jennifer Hawkins - 2021 - Philosophy, Psychiatry, and Psychology 28 (2):155-158.
    Most adult persons with anorexia satisfy the existing criteria widely used to assess decision-making capacity, meaning that incapacity typically cannot be used to justify coercive intervention. After rejecting two other approaches to justification, Professor Radden concludes that it is most likely not possible to justify coercive medical intervention for persons with anorexia in liberal terms, though she leaves it open whether some other framework might succeed. I shall assume here that the standard approach to assessing decisionmaking capacity is adequate.1 The (...)
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  • A Puzzling Anomaly: Decision-Making Capacity and Research on Addiction.Louis C. Charland - 2020 - Oxford Handbook of Research Ethics.
    Any ethical inquiry into addiction research is faced with the preliminary challenge that the term “addiction” is itself a matter of scientific and ethical controversy. Accordingly, the chapter begins with a brief history of the term “addiction.” The chapter then turns to ethical issues surrounding consent and decision-making capacity viewed from the perspective of the current opioid epidemic. One concern is the neglect of the cyclical nature of addiction and the implications of this for the validity of current psychometric instruments (...)
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  • Psychiatric Ethics: A History.Louis C. Charland - forthcoming - In Psychiatric Ethics 5th Edition. New York, NY, USA:
    The chapter traces the history of psychiatric ethics with a focus on the emergence of autonomy and how assumptions and thresholds surrounding informed consent and decision-making capacity have changed over the centuries. Innovators like Philippe PInel and William Tuke are featured in this account of how the 'mad' and the abuses of the 'domestication paradigm' of madness eventually gave way to more humanitarian approaches of treating the 'mad', like moral treatment. The chapter closes with a brief reflection regarding the limits (...)
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  • (1 other version)Decision-Making Capacity.Jennifer Hawkins & Louis C. Charland - 2020 - Stanford Encyclopedia of Philosophy.
    Decision-Making Capacity First published Tue Jan 15, 2008; substantive revision Fri Aug 14, 2020 In many Western jurisdictions the law presumes that adult persons, and sometimes children that meet certain criteria, are capable of making their own medical decisions; for example, consenting to a particular medical treatment, or consenting to participate in a research trial. But what exactly does it mean to say that a subject has or lacks the requisite capacity to decide? This question has to do with what (...)
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  • Ethical Practices and Legal Challenges in Mental Health Research.Smita N. Deshpande, Vishwajit L. Nimgaonkar, Triptish Bhatia, Nagendra Narayan Mishra, Rajesh Nagpal & Lisa S. Parker - 2020 - Asian Bioethics Review 12 (2):87-102.
    Considerations of justice and concern for well-being support conducting mental health research and addressing ethical concerns specific to mental health research are critical. We discuss these concerns, provide recommendations to enable the ethical conduct of mental health research, and argue that participants’ interests should be given primary weight in resolving apparent dilemmas. We also comment on provisions of two legislative actions in India relevant to mental health research: Rights of Persons with Disability Act 2016 and the Mental Health Care Act (...)
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  • Empowerment or Engagement? Digital Health Technologies for Mental Healthcare.Christopher Burr & Jessica Morley - 2020 - In Christopher Burr & Silvia Milano (eds.), The 2019 Yearbook of the Digital Ethics Lab. Springer Nature. pp. 67-88.
    We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns using five key (...)
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  • Psychopathy: Morally Incapacitated Persons.Heidi Maibom - 2017 - In Thomas Schramme & Steven Edwards (eds.), Handbook of the Philosophy of Medicine. Springer. pp. 1109-1129.
    After describing the disorder of psychopathy, I examine the theories and the evidence concerning the psychopaths’ deficient moral capacities. I first examine whether or not psychopaths can pass tests of moral knowledge. Most of the evidence suggests that they can. If there is a lack of moral understanding, then it has to be due to an incapacity that affects not their declarative knowledge of moral norms, but their deeper understanding of them. I then examine two suggestions: it is their deficient (...)
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  • The Bite of Rights in Paternalism.Norbert Paulo - 2015 - In Thomas Schramme (ed.), New Perspectives on Paternalism and Health Care. Cham: Springer Verlag.
    This paper scrutinizes the tension between individuals’ rights and paternalism. I will argue that no normative account that includes rights of individuals can justify hard paternalism since the infringement of a right can only be justified with the right or interest of another person, which is never the case in hard paternalism. Justifications of hard paternalistic actions generally include a deviation from the very idea of having rights. The paper first introduces Tom Beauchamp as the most famous contemporary hard paternalist (...)
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  • Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists.Manne Sjöstrand, Petter Karlsson, Lars Sandman, Gert Helgesson, Stefan Eriksson & Niklas Juth - 2015 - BMC Medical Ethics 16 (1):34.
    Decision-making capacity is a key concept in contemporary healthcare ethics. Previous research has mainly focused on philosophical, conceptual issues or on evaluation of different tools for assessing patients’ capacity. The aim of the present study is to investigate how the concept and its normative role are understood in Swedish psychiatric care. Of special interest for present purposes are the relationships between decisional capacity and psychiatric disorders and between health law and practical ethics.
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  • Evaluating Medico-Legal Decisional Competency Criteria.Demian Whiting - 2015 - Health Care Analysis 23 (2):181-196.
    In this paper I get clearer on the considerations that ought to inform the evaluation and development of medico-legal competency criteria—where this is taken to be a question regarding the abilities that ought to be needed for a patient to be found competent in medico-legal contexts. In the “Decisional Competency in Medico-Legal Contexts” section I explore how the question regarding the abilities that ought to be needed for decisional competence is to be interpreted. I begin by considering an interpretation that (...)
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  • Depression, possibilities, and competence: A phenomenological perspective. [REVIEW]Gerben Meynen - 2011 - Theoretical Medicine and Bioethics 32 (3):181-193.
    Competent decision-making is required for informed consent. In this paper, I aim, from a phenomenological perspective, to identify the specific facets of competent decision-making that may form a challenge to depressed patients. On a phenomenological account, mood and emotions are crucial to the way in which human beings encounter the world. More precisely, mood is intimately related to the options and future possibilities we perceive in the world around us. I examine how possibilities should be understood in this context, and (...)
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  • Autonomy and Depression.Lubomira Radoilska - 2012 - In K. W. M. Fulford (ed.), Oxford Handbook of Philosophy and Psychiatry. Oxford: Oxford University Press. pp. 1155-1170.
    In this paper, I address two related challenges the phenomenon of depression raises for conceptions according to which autonomy is an agency concept and an independent source of justification. The first challenge is directed at the claim that autonomous agency involves intending under the guise of the good: the robust though not always direct link between evaluation and motivation implied here seems to be severed in some instances of depression; yet, this does not seem to affect the possibility of autonomous (...)
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  • Personal Autonomy, Decisional Capacity, and Mental Disorder.Lubomira V. Radoilska - 2012 - In Lubomira Radoilska (ed.), Autonomy and Mental Disorder. Oxford University Press.
    In this Introduction, I situate the underlying project “Autonomy and Mental Disorder” with reference to current debates on autonomy in moral and political philosophy, and the philosophy of action. I then offer an overview of the individual contributions. More specifically, I begin by identifying three points of convergence in the debates at issue, stating that autonomy is: 1) a fundamentally liberal concept; 2) an agency concept and; 3) incompatible with (severe) mental disorder. Next, I explore, in the context of decisional (...)
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  • Subsequent Consent and Blameworthiness.Jason Chen - 2020 - HEC Forum 32 (3):239-251.
    Informed consent is normally understood as something that a patient gives prior to a medical intervention that can render it morally permissible. Whether or not it must be given prior to the intervention is debated. Some have argued that subsequent consent—that is, consent given after a medical intervention—can also render an otherwise impermissible act permissible. If so, then a patient may give her consent to an intervention that has already been performed and thereby justify a physician’s act retroactively. The purpose (...)
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  • Informed consent and justified hard paternalism.Emma Cecelia Bullock - 2012 - Dissertation, University of Birmingham
    According to the doctrine of informed consent medical procedures are morally permissible when a patient has consented to the treatment. Problematically it is possible for a patient to consent to or refuse treatment which consequently leads to a decline in her best interests. Standardly, such conflicts are resolved by prioritising the doctrine of informed consent above the requirement that the medical practitioner acts in accordance with the duty of care. This means that patient free choice is respected regardless as to (...)
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  • Relational Capacity: Broadening the Notion of Decision-Making Capacity in Paediatric Healthcare.Katharina M. Ruhe, Eva De Clercq, Tenzin Wangmo & Bernice S. Elger - 2016 - Journal of Bioethical Inquiry 13 (4):515-524.
    Problems arise when applying the current procedural conceptualization of decision-making capacity to paediatric healthcare: Its emphasis on content-neutrality and rational cognition as well as its implicit assumption that capacity is an ability that resides within a person jeopardizes children’s position in decision-making. The purpose of the paper is to challenge this dominant account of capacity and provide an alternative for how capacity should be understood in paediatric care. First, the influence of developmental psychologist Jean Piaget upon the notion of capacity (...)
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  • Privacy challenges in smart homes for people with dementia and people with intellectual disabilities.Fiachra O’Brolcháin & Bert Gordijn - 2019 - Ethics and Information Technology 21 (3):253-265.
    The aim of this paper is to analyse the ethical issues relating to privacy that arise in smart homes designed for people with dementia and for people with intellectual disabilities. We outline five different conceptual perspectives on privacy and detail the ways in which smart home technologies may violate residents’ privacy. We specify these privacy threats in a number of areas and under a variety of conceptions of privacy. Furthermore, we illustrate that informed consent may not provide a solution to (...)
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  • The Best Interest Standard: An Exhaustive Guide for Medical Decision Making in Pediatrics?Eva De Clercq & Katharina Ruhe - 2018 - American Journal of Bioethics 18 (8):69-71.
    In his article, Bester (2018) criticizes the so-called “harm consensus” movement among a growing number of bioethicists and practitioners. He argues that the harm principle is unable to replace the...
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  • Is decision-making capacity an “essentially contested” concept in pediatrics?Eva De Clercq, Katharina Ruhe, Michel Rost & Bernice Elger - 2017 - Medicine, Health Care and Philosophy 20 (3):425-433.
    Key legislations in many countries emphasize the importance of involving children in decisions regarding their own health at a level commensurate with their age and capacities. Research is engaged in developing tools to assess capacity in children in order to facilitate their responsible involvement. These instruments, however, are usually based on the cognitive criteria for capacity assessment as defined by Appelbaum and Grisso and thus ill adapted to address the life-situation of children. The aim of this paper is to revisit (...)
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  • High court should not restrict access to puberty blockers for minors.Cameron Beattie - 2022 - Journal of Medical Ethics 48 (1):71-76.
    Gender dysphoria is a clinically significant incongruence between expressed gender and assigned gender, with rapidly growing prevalence among children. The UK High Court recently conducted a judicial review regarding the service provision at a youth-focussed gender identity clinic in Tavistock. The high court adjudged it ‘highly unlikely’ that under-13s, and ‘doubtful’ that 14–15 years old, can be competent to consent to puberty blocker therapy for GD. They based their reasoning on the limited evidence regarding efficacy, the likelihood of progressing to (...)
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  • Exploring the similarities and differences between medical assessments of competence and criminal responsibility.Gerben Meynen - 2009 - Medicine, Health Care and Philosophy 12 (4):443-451.
    The medical assessments of criminal responsibility and competence to consent to treatment are performed, developed and debated in distinct domains. In this paper I try to connect these domains by exploring the similarities and differences between both assessments. In my view, in both assessments a decision-making process is evaluated in relation to the possible influence of a mental disorder on this process. I will argue that, in spite of the relevance of the differences, both practices could benefit from the recognition (...)
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  • Unreasonable reasons: normative judgements in the assessment of mental capacity.Natalie F. Banner - 2012 - Journal of Evaluation in Clinical Practice 18 (5):1038-1044.
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  • Do we need a threshold conception of competence?Govert den Hartogh - 2016 - Medicine, Health Care and Philosophy 19 (1):71-83.
    On the standard view we assess a person’s competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her (‘hard paternalism’). In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not (...)
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  • From Libertarian Paternalism to Nudging—and Beyond.Adrien Barton & Till Grüne-Yanoff - 2015 - Review of Philosophy and Psychology 6 (3):341-359.
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  • Should Neuroscience Inform Judgements of Decision-Making Capacity?Andrew Peterson - 2018 - Neuroethics 12 (2):133-151.
    In this article, I present an argument that suggests neuroscience should inform judgments of decision-making capacity. First, I review key behavioral and neurocognitive data to demonstrate that neuroscientific tests might be predictive of decision-making capacity, and that these tests might inform clinical judgments of capacity. Second, I argue that, consistent with the principles of autonomy and justice, such data should inform judgements of decision-making capacity. While the neuroscience of decision-making capacity still requires time to mature, there is strong reason to (...)
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  • Assessing Decision-Making Capacity: A Primer for the Development of Hospital Practice Guidelines.Andrew M. Siegel, Anna S. Barnwell & Dominic A. Sisti - 2014 - HEC Forum 26 (2):159-168.
    Decision making capacity (DMC) is a fundamental concept grounding the principle of respect for autonomy and the practice of obtaining informed consent. DMC must be determined and documented every time a patient undergoes a hospital procedure and for routine care when there is reason to believe decision making ability is compromised. In this paper we explore a path toward ethically informed development and implementation of a hospital policy related to DMC assessment. We begin with a review of the context of (...)
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  • Participation of Children in Medical Decision-Making: Challenges and Potential Solutions.Vida Jeremic, Karine Sénécal, Pascal Borry, Davit Chokoshvili & Danya F. Vears - 2016 - Journal of Bioethical Inquiry 13 (4):525-534.
    Participation in healthcare decision-making is considered to be an important right of minors, and is highlighted in both international legislation and public policies. However, despite the legal recognition of children’s rights to participation, and also the benefits that children experience by their involvement, there is evidence that legislation is not always translated into healthcare practice. There are a number of factors that may impact on the ability of the child to be involved in decisions regarding their medical care. Some of (...)
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  • Assessing Decision-Making Capacity After Severe Brain Injury.Andrew Peterson - unknown
    Severe brain injury is a leading cause of death and disability. Following severe brain injury diagnosis is difficult and errors frequently occur. Recent findings in clinical neuroscience may offer a solution. Neuroimaging has been used to detect preserved cognitive function and awareness in some patients clinically diagnosed as being in a vegetative state. Remarkably, neuroimaging has also been used to communicate with some vegetative patients through a series of yes/no questions. Some have speculated that, one day, this method may allow (...)
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