Abstract
Mental capacity is a fundamental determinant of an individual’s ability to make autonomous decisions. Respect for autonomy is a legal and ethical requirement in health-care provision, which necessitates that a person’s autonomous wishes be respected and informed consent validly obtained before therapeutic intervention is carried out. In Britain and many other Western jurisdictions, mental capacity legislation has developed with the aim of providing a framework for the assessment of mental capacity in health care, in a decision-specific context. Where a patient is judged to lack mental capacity with regard to a decision, the duty to respect autonomy is superseded by the duty to act beneficently and/or prevent harm which might otherwise occur due to the patient’s lack of capacity. Mental capacity legislation typically provides procedural criteria for assessing task-specific competence in terms of comprehension, appraisal, and communication. Procedural criteria do not however specify a threshold for competency assessment, or provide guidance on evaluation of irrational belief systems. Procedural assessment of mental capacity may therefore provide only a partial indication of a person’s autonomy, and further evidence in terms of instrumental rationality may be necessary to evaluation of capacity.
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
References
Beauchamp TL (1986) Suicide. In: Regan T (ed) Matters of life and death, 2nd edn. Random House, New York, pp 77–124
Beauchamp T, Childress J (2009) Principles of biomedical ethics. Oxford University Press, New York
Beck AT, Clark DA (1997) An information processing model of anxiety: automatic and strategic processes. Behav Res Ther 35:49–58
Belhouse J, Holland A, Clare I et al (2003) Capacity-based mental health legislation and its impact on clinical practice: 2. treatment in hospital. J Ment Health Law 24–28
Benjamin M, Curtis J (1986) Ethics in nursing, 2nd edn. Oxford University Press, New York
Blackburn S (2005) Oxford dictionary of philosophy, 2nd edn. Oxford University Press, Oxford
Breden TM, Vollmann J (2004) The cognitive based approach of capacity assessment in psychiatry: a philosophical critique of the MacCAT-T. Health Care Anal 12(4):273–283
Brudney D, Lantos J (2011) Agency and authenticity: which value grounds patient choice? Theor Med Bioeth 32(4):217–227
Buchanan A (2004) Mental capacity, legal competence and consent to treatment. J R Soc Med 97:415–420
Cairns R, Maddock C, Buchanan A, David A, Hayward P, Richardson G, Szmukler G, Hotopf M (2005) Prevalence and predictors of mental incapacity in psychiatric in-patients. Br J Psychiatry 187:379–385
Cairns R, Richardson G, Hotopf M (2010) Deprivation of liberty: mental capacity act safeguards versus the mental health act. Psychiatrist 34:246–247
Carroll A, Fattah S, Clyde Z, Coffey I, Owens DG, Johnstone EC (1999) Correlates of insight and insight change in schizophrenia. Schizophr Res 35:247–253
Charland LC (2014) Decision-making capacity. In: Zalta EN (ed) The Stanford encyclopedia of Philosophy, Fall 2014 edn. forthcoming. http://plato.stanford.edu/archives/fall2014/entries/decision-capacity/. Accessed 20 Aug 2014
Cherry MJ (2010) Non-consensual treatment is (nearly always) morally impermissible. J Law Med Ethics 38(4):789–798
Chiswick D (2005) Commentary: test of capacity has little practical benefit. Br Med J 331:1469
Cholbi M (2009) Tonkens on the irrationality of the suicidally mentally ill. J Appl Philos 26(1):102–106
Craige J (2013) Introduction: mental capacity and value neutrality. Int J Law Context 9(SI 01):1–3
Culver CM, Gert B (1982) Philosophy in medicine: conceptual and ethical issues in medicine and psychiatry. Oxford University Press, New York
Dawson J (2008) Mental capacity and psychiatric admission. Br Med J 337:5–6
Department of Health (2005) Mental capacity act. HMSO, London
Department of Health (2015) Mental Health Act 1983 Code of Practice. HMSO, London
Dimond B (2008) Legal aspects of nursing, 5th edn. Pearson Education, Harlow
Dresser R (1996) Mentally disabled research subjects: the enduring policy issues. JAMA 276(1):67–72
Dworkin G (1988) The theory and practice of autonomy. Cambridge University Press, New York
Edwards RB (1982) Mental health as rational autonomy. In: Edwards RB (ed) Psychiatry and ethics. Prometheus, New York, pp 68–78
Etchells E, Darzins P, Silberfeld M, Singer PA, McKenny J, Naglie G, Katz M, Guyatt GH, Molloy DW, Strang D (1999) Assessment of patient capacity to consent to treatment. J Gen Intern Med 14:27–34
Fay B (1996) Contemporary philosophy of social science. Blackwell, Oxford
Fried TR, Bradley EH, O’Leary J (2003) Prognosis communication in serious illness: perceptions of older patients, caregivers, and clinicians. J Am Geriatr Soc 51:398–1403
Graham G (1998) Philosophy of mind: an introduction, 2nd edn. Blackwell, Malden
Grisso T, Appelbaum PS (1995) The MacArthur Competence Treatment Study: III. Abilities of patients to consent to psychiatric and medical treatments. Law Hum Behav 19:149–174
Grisso T, Appelbaum PS, Hill-Fotouhi C (1997) The MacCAT-T: a clinical tool to assess patients’ capacities to make treatment decisions. Psychiatr Serv 48:1415–1419
Guttenplan S (1999) A companion to the philosophy of mind. Blackwell, London
Hewitt J (2010) Rational suicide: philosophical perspectives on schizophrenia. Med Health Care Philos 13:25–31
Hewitt J, Edwards SD (2006) Moral perspectives on the prevention of suicide in mental health settings. J Psychiatr Ment Health Nurs 13:665–672
Hindmarch T, Hotopf M, Owen GS (2013) Depression and decision-making capacity for treatment or research: a systematic review. BMC Med Ethics 14:54
Hotopf M (2005) The assessment of mental capacity. Clin Med 5(6):580–584
Jacob R, Gunn MJ, Holland A (eds) (2013) Mental capacity legislation: principles and practice. RCPsych Publications, London
Jarrett M, Bowers L, Simpson A (2008) Coerced medication in psychiatric inpatient care: literature review. J Adv Nurs 64:538–548
Jensen UJ, Mooney G (eds) (1990) Changing values in medical and healthcare decision-making. Wiley, Chichester
Keinan G (1987) Decision making under stress: scanning of alternatives under controllable and uncontrollable threats. J Pers Soc Psychol 52:639
Kemp R, Chua S, McKenna P, David A (1997) Reasoning and delusions. Br J Psychiatry 170:398–405
Kim S, Appelbaum P, Swan J, Stroup S, McEvoy J, Goff D, Jeste D, Lanberti S, Leibovici A, Caine E (2007) Determining when impairment constitutes incapacity for informed consent in schizophrenia research. Br J Psychiatry 191:38–43
Mintz AR, Dobson KS, Romney DM (2003) Insight in schizophrenia: a meta-analysis. Schizophr Res 61(1):75–88
Nelson RM, Beauchamp T, Miller VA, Reynolds W, Ittenbach RF, Luce MF (2011) The concept of voluntary consent. Am J Bioeth 11:6–16
Nicholson T, Cutter W, Hotopf M (2008) Assessing mental capacity: the Mental Capacity Act. Br Med J 336:322–325
Nordenfelt L (2007) Rationality and compulsion. Oxford University Press, Oxford
Okai D, Owen G, McGuire H, Singh S, Churchill R, Hotopf M (2007) Mental capacity in psychiatric patients. Br J Psychiatry 191:291–297
Owen G, Cutting J, David A (2007) Are people with schizophrenia more logical than healthy volunteers? Br J Psychiatry 191:453–454
Owen G, Richardson G, David A, Szmukler G, Hayward P, Hotopf M (2008) Mental capacity to make decisions on treatment in people admitted to psychiatric hospitals: cross sectional study. Br Med J 337:448
Stanovich K (2011) Rationality and the reflective mind. Oxford University Press, New York
Svavarsdottir S (2008) The virtue of practical rationality. Philos Phenomenol Res 77:1–33
Szmukler G, Appelbaum PS (2008) Treatment pressures, leverage, coercion, and compulsion in mental health care. J Ment Health 17:233–244
Tschanz JT, Corcoran CD, Schwartz S, Treiber K, Green RC, Norton MC, Lyketsos CG (2011) Progression of cognitive, functional and neuropsychiatric symptom domains in a population cohort with Alzheimer’s dementia the cache county dementia progression study. Am J Geriatr Psychiatry 19(6):532
Varelius J (2003) Autonomy, subject-relativity, and subjective and objective theories of well-being in bioethics. Theor Med 24:363–379
Wallace RJ. Practical reason. In: Zalta EN (ed) The Stanford encyclopedia of philosophy, Summer 2014 edn. http://plato.stanford.edu/archives/sum2014/entries/practical-reason/. Accessed 2 Sept 2014
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media Dordrecht
About this entry
Cite this entry
Hewitt, J. (2015). Mental Capacity of Adult Patients in Health Care. In: Schramme, T., Edwards, S. (eds) Handbook of the Philosophy of Medicine. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-8706-2_28-1
Download citation
DOI: https://doi.org/10.1007/978-94-017-8706-2_28-1
Received:
Accepted:
Published:
Publisher Name: Springer, Dordrecht
Online ISBN: 978-94-017-8706-2
eBook Packages: Springer Reference Religion and PhilosophyReference Module Humanities and Social SciencesReference Module Humanities