Mental Capacity and Decisional Autonomy: An Interdisciplinary Challenge

With the waves of reform occurring in mental health legislation in England and other jurisdictions, mental capacity is set to become a key medico-legal concept. The concept is central to the law of informed consent and is closely aligned to the philosophical concept of autonomy. It is also closely related to mental disorder. This paper explores the interdisciplinary terrain where mental capacity is located. Our aim is to identify core dilemmas and to suggest pathways for future interdisciplinary research. The terrain can be separated into three types of discussion: philosophical, legal and psychiatric. Each discussion approaches mental capacity and judgmental autonomy from a different perspective yet each discussion struggles over two key dilemmas: whether mental capacity and autonomy is/should be a moral or a psychological notion and whether rationality is the key constitutive factor. We suggest that further theoretical work will have to be interdisciplinary and that this work offers an opportunity for the law to enrich its interpretation of mental capacity, for psychiatry to clarify the normative elements latent in its concepts and for philosophy to advance understanding of autonomy through the study of decisional dysfunction. The new pressures on medical and legal practice to be more explicit about mental capacity make this work a priority

Certainty in Action

When is it permissible to rely on a proposition in practical reasoning? Standard answers to this question face serious challenges. This paper uses these challenges to motivate a certainty norm of practical reasoning. This norm holds that one is permitted to rely on p in practical reasoning if and only if p is epistemically certain. After developing and defending this norm, I consider its broader implications. Taking a certainty norm seriously calls into question traditional assumptions about the importance of belief and knowledge. In particular, it raises the possibility that many epistemological jobs that are usually assigned to belief and knowledge should be reallocated to two related but importantly different states: psychological and epistemic certainty

A conceptual treadmill: the need for ‘middle ground’ in clinical decision making theory in nursing

This paper explores the two predominant theoretical approaches to the process of nurse decision making prevalent within the nursing research literature: systematic-positivistic approaches as exemplifed by information processing theory, and the intuitive-humanistic approach of Patricia Benner. The two approaches' strengths and weaknesses are explored and as a result a third theoretical stance is proffered: the idea of a cognitive continuum. According to this approach the systematic and intuitive theoretical camps occupy polar positions at either end of a continuum as opposed to separate theoretical planes. The methodological and professional benefits of adopting such a stance are also briefly outlined

Values based practice and authoritarianism

Values based practice (VBP) is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional but misguided views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But, in the work of KWM (Bill) Fulford, it goes further in the form of a radical liberal view: that the idea of an antecedently good outcome should be replaced by that of a right process. That however leads to a dilemma as to whether it can account for its own normative status. Given that difficulty, why might one adopt the radical version? I sketch a possible motive drawing on Rorty’s rejection of authoritarianism which replaces objectivity with solidarity as the aim of judgement. But I argue that, nevertheless, this does not justify the rejection of the more modest particularist version of VBP

Pushing the bounds of rationality: Argumentation and extended cognition

One of the central tasks of a theory of argumentation is to supply a theory of appraisal: a set of standards and norms according to which argumentation, and the reasoning involved in it, is properly evaluated. In their most general form, these can be understood as rational norms, where the core idea of rationality is that we rightly respond to reasons by according the credence we attach to our doxastic and conversational commitments with the probative strength of the reasons we have for them. Certain kinds of rational failings are so because they are manifestly illogical – for example, maintaining overtly contradictory commitments, violating deductive closure by refusing to accept the logical consequences of one’s present commitments, or failing to track basing relations by not updating one’s commitments in view of new, defeating information. Yet, according to the internal and empirical critiques, logic and probability theory fail to supply a fit set of norms for human reasoning and argument. Particularly, theories of bounded rationality have put pressure on argumentation theory to lower the normative standards of rationality for reasoners and arguers on the grounds that we are bounded, finite, and fallible agents incapable of meeting idealized standards. This paper explores the idea that argumentation, as a set of practices, together with the procedures and technologies of argumentation theory, is able to extend cognition such that we are better able to meet these idealized logical standards, thereby extending our responsibilities to adhere to idealized rational norms

Radical liberal values-based practice.

Values based practice is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But it goes further in the adoption of a radical liberal view: that right or good outcome should be replaced by right process. I describe each of these three claims but caution against the third

Improving bioethical decision-making with a little help from legal argumentation

The most appropriate method for clinical decision-making is deliberation. The deliberative procedure aims to achieve wise and prudent decisions about health care taking into account facts, values and norms. Since deliberative reasoning is shared by healthcare professions, ethics and law, this paper introduces the structure and features of the bioethical deliberative procedure and suggests to improve it with some contributions from legal science and theories of argumentation.El método más adecuado para la toma de decisiones biomédicas es la deliberación. El procedimiento deliberativo pretende alcanzar decisiones prudentes y razonables tras tomar en consideración hechos, valores y normas. Al ser la racionalidad deliberativa un rasgo compartido por las profesiones asistenciales, la ética y el derecho, el presente artículo expone la estructura y las características del método bioético deliberativo y propone mejorarla mediante algunas contribuciones de la ciencia jurídica y las teorías de la argumentación