Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of “personality disorder” is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and may become, (...) in itself, a therapeutic intervention. (shrink)

[opening paragraph] -- Clark: The `astonishing hypothesis' which you put forward in your book, and which you obviously feel is very controversial, is that `You, your joys and sorrows, your memories and ambitions, your sense of personal identity and free will are, in fact, no more than the behaviour of a vast assembly of nerve cells. As Lewis Carroll's Alice might have phrased it: `You're nothing but a pack of neurons'.' But it seems to me that this is not so (...) astonishing a statement for a scientist to make. Isn't this what reductionist science has always believed? (shrink)

[opening paragraph] -- Clark: The `astonishing hypothesis' which you put forward in your book, and which you obviously feel is very controversial, is that `You, your joys and sorrows, your memories and ambitions, your sense of personal identity and free will are, in fact, no more than the behaviour of a vast assembly of nerve cells. As Lewis Carroll's Alice might have phrased it: `You're nothing but a pack of neurons'.' But it seems to me that this is not so (...) astonishing a statement for a scientist to make. Isn't this what reductionist science has always believed? (shrink)

The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor–patient relationship within which consent is given.