The Cognitive Based Approach of Capacity Assessment in Psychiatry: A Philosophical Critique of the MacCAT-T [Book Review]

Health Care Analysis 12 (4):273-283 (2004)

Abstract
This article gives a brief introduction to the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and critically examines its theoretical presuppositions. On the basis of empirical, methodological and ethical critique it is emphasised that the cognitive bias that underlies the MacCAT-T assessment needs to be modified. On the one hand it has to be admitted that the operationalisation of competence in terms of value-free categories, e.g. rational decision abilities, guarantees objectivity to a great extent; but on the other hand it bears severe problems. Firstly, the cognitive focus is in itself a normative convention in the process of anthropological value-attribution. Secondly, it misses the complexity of the decision process in real life. It is therefore suggested that values, emotions and other biographic and context specific aspects should be considered when interpreting the cognitive standards according to the MacArthur model. To fill the gap between cognitive and non-cognitive approaches the phenomenological theory of personal constructs is briefly introduced. In conclusion some main demands for further research to develop a multi-step model of competence assessment are outlined
Keywords MacCAT-T  capacity  competence  decision-making  ethics  psychiatry
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DOI 10.1007/s10728-004-6635-x
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References found in this work BETA

Ought We to Require Emotional Capacity as Part of Decisional Competence?Paul S. Appelbaum - 1998 - Kennedy Institute of Ethics Journal 8 (4):377-387.

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Citations of this work BETA

Unreasonable Reasons: Normative Judgements in the Assessment of Mental Capacity.Natalie F. Banner - 2012 - Journal of Evaluation in Clinical Practice 18 (5):1038-1044.

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