A key objective of the law in the assessment of decision-making capacity in clinical settings is to allow clinicians and judges to avoid making value judgements about the reasons that patients use to refuse treatment. This paper advances two lines of argument in respect of this objective. The first is that authorities cannot rationally avoid significant evaluative judgements in the assessment of a patient’s own assessment of the facts of their case. Assessing reasoning is unavoidably value-laden. Yet the underlying motivation (...) behind clinicians’ and the law’s value-neutral aims, ie, the avoidance of undue paternalism, is worth preserving. That being so, the second line of argument will try to show that that underlying motivation is better served in a limited range of cases by embedding a ‘reversibility standard’ in the assessment process so that the patient can, if they wish, and in due course, bring about the consequences that they were prevented from realising as a result of a determination of incapacity. (shrink)

This article advances two views on the role of evaluative judgment in clinical assessments of decision-making capacity. The first is that it is rationally impossible for such assessments to exclude judgments of the values a patient uses to motivate their decision-making. Predictably, and second, attempting to exclude such judgments sometimes yields outcomes that contain intractable dilemmas that harm patients. These arguments count against the prevailing model of assessment in common law countries—the four abilities model—which is often incorrectly advertised as being (...) value-neutral in respect of patient decision-making both by its proponents and in statute. A straightforward evaluative model of capacity assessment which wears its values on its sleeves and is biased against what are called ‘serious prudential mistakes’ avoids these rational and practical problems. (shrink)

This article takes up the question of whether legal rules are reasons for action. They are commonly regarded in this way, yet are legal rules reasons for action themselves (the reflexivity thesis) or are they instead merely statements of other reasons that we may already have (the paraphrastic thesis)? I argue for a version of the paraphrastic thesis. In doing so, considerable attention is given to the neglected but important puzzle of the opaqueness of rules, which arises out of what (...) some regard as the gap between the evaluative grounds of legal rules and what makes them into reasons for action. After examining an important articulation of the puzzle in the work of Joseph Raz, I argue that the reflexivity thesis is (i) undermined by certain features of rule making and (ii) defeated by the principle of presumptive sufficiency. The result is that it is possible for legal rules to be paraphrastic statements of reasons but, conversely, impossible for them to be reasons in themselves. (shrink)

It is not uncommon for people to hold bizarre views. Sometimes, these views appear before the courts in mental capacity cases. Judges must then decide if the views are so bizarre that they constitute evidence of incapacity or, instead, if those views are the everyday sort that do not constitute such evidence. The idea behind the distinction is that the everyday sort can be false but, in some important sense, not that unreasonable. But what should tip the balance of reasons (...) for a view to count as severely unreasonable rather than merely so? It turns out that capacity law is unable to provide a principled answer to this question because it lacks a standard to parse beliefs. This paper offers such a standard, focussing on the ability to reason, or the ‘use and weigh’ criterion, which features in most capacity statutes. The standard takes the form of a threshold with four necessary conditions. The main idea is that when a person's belief satisfies those conditions, it counts as evidence of an inability to reason. The standard's objective is to displace the various unarticulated conceptions of reasonableness which judges are currently compelled to use to determine questions of reasoning ability. (shrink)