
Contents
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An expanded notion of ‘decision-making capability’ An expanded notion of ‘decision-making capability’
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Beyond a ‘cognitive’ or ‘procedural’ view Beyond a ‘cognitive’ or ‘procedural’ view
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Decision-making capability and the role of ‘interpretation’ Decision-making capability and the role of ‘interpretation’
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‘Principle of Charity’ ‘Principle of Charity’
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Interpretation in practice Interpretation in practice
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‘Understandability’ ‘Understandability’
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Values can change Values can change
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Rethinking ‘best interests’ in the light of interpretation Rethinking ‘best interests’ in the light of interpretation
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Problematic situations Problematic situations
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Relevance to coercive interventions Relevance to coercive interventions
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References References
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12 Emergencies, general medicine, ‘community treatment orders’, and ‘psychiatric advance statements’
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7 On being able to make decisions and making decisions for others
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Published:November 2017
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Abstract
In this chapter, the meaning of ‘decision-making capacity’ is examined. A ‘procedural’, ‘value-free’ notion of its assessment is inadequate, especially in difficult cases where a consideration of a person’s ‘values’ may be unavoidable. An approach influenced by Davidson’s ‘radical interpretation’ is proposed, in which, under the ‘Principle of Charity’, a person’s system of beliefs and values is presumed to be, by and large, ‘coherent’. It asks how coherent are the present beliefs underlying a person’s apparently unwise treatment decision—how well do they fit with their previously deeply held beliefs and value commitments? A disruption of coherence may suggest an undermining of a person’s decision-making ability. The meaning of ‘best interests’ is also clarified in this context; it may mean giving effect to the person’s deep value commitments. Problematic situations are examined where questions arise concerning whether changes in a person’s values are of a nature that undermine decision-making or not. Dementia is an example.
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