Why Decision-making Capacity Matters

Journal of Moral Philosophy 19 (5):447-473 (2021)
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Abstract

Decision-making Capacity matters to whether a patient’s decision should determine her treatment. But why it matters in this way isn’t clear. The standard story is that dmc matters because autonomy matters. And this is thought to justify dmc as a gatekeeper for autonomy – whereby autonomy concerns arise if but only if a patient has dmc. But appeals to autonomy invoke two distinct concerns: concern for authenticity – concern that a choice is consistent with an individual’s commitments; and concern for sovereignty – concern that an individual exercises control over that which is hers to control. Here, I argue, neither concern can alone explain why dmc matters. Instead, dmc matters because it indicates a harmony between the two concerns – the demands of each concern are more likely to agree if a patient has dmc. This vindicates the standard story, but also makes clear that dmc is an inappropriate gatekeeper for autonomy.

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Ben Schwan
Case Western Reserve University

Citations of this work

Ditching Decision-Making Capacity.Daniel Fogal & Ben Schwan - forthcoming - Journal of Medical Ethics.
Authority, Autonomy, and Capacity.Daniel Fogal & Ben Schwan - 2022 - American Journal of Bioethics 22 (11):97-99.
Sovereignty, authenticity and the patient preference predictor.Ben Schwan - 2022 - Journal of Medical Ethics 48 (5):311-312.
On the Relationship between Competence and Welfare.Daniel Fogal & Ben Schwan - 2022 - American Journal of Bioethics 22 (10):73-75.

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References found in this work

Principles of biomedical ethics.Tom L. Beauchamp - 1983 - New York: Oxford University Press. Edited by James F. Childress.
Deciding for Others: The Ethics of Surrogate Decision Making.Allen E. Buchanan & Dan W. Brock - 1989 - New York: Cambridge University Press. Edited by Dan W. Brock.

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