Values, autonomy and capacity
The notion of capacity implicit in the Mental Capacity Act is subject to a tension between two claims. On the one hand, capacity is assessed relative to a particular decision. It is the capacity to make one kind of judgement, specifically, rather than another. So one can have capacity in one area whilst not having it in another.
On the other hand, capacity is supposed to be independent of the ‘wisdom’ or otherwise of the decision made. (‘A person is not to be treated as unable to make a decision merely because he makes an unwise decision.’ [Department of Constitutional Affairs 2005: section 1].) One may have capacity even if the decision one arrives at is seen as unwise by one’s doctor. This suggests a tension: how is capacity to be determined in cases where patients or service users do make unwise decisions in the eyes of carers? Can the idea of capacity be kept separate from the agreement or not on values?
Reading:
Thornton, T. (2011) ‘Capacity, mental mechanisms and unwise decisions’ Philosophy Psychiatry and Psychology