A virtue ethical approach to decisional capacity and mental health

Abstract

It is a common assumption that lack of autonomy is incompatible with decisional capacity and mental health. However, there are two general conceptions of autonomy, one value-neutral and the other value-laden, which imply different notions of mental health. I argue that the value-neutral notion of autonomy is independently inadequate and that it also provides an inadequate foundation for judging whether someone is decisionally incapable or mentally disordered. I propose an alternative, value-laden account which posits ten capabilities required for basic human functioning. I then defend this account against objections and highlight its practical utility in designing optimal treatment.

Keywords:

• Autonomy
• capability approach
• decisional capacity
• mental health
• psychological disorder
• virtue ethics

Notes

¹ We might want to restrict interpretation of the “significant harm” clause of decisional incapacity to capabilities 1–4, which are directly relevant to harm, in order to prevent overzealous judgments. Still, all capabilities are relevant to the “best interests” constraint on treatment.

² Mad studies, in the words of Peter Beresford, is an alternative to the medical model, which aims to develop “democratic and feasible alternatives to support our understandings of and responses to madness and distress at both individual and societal levels” (2013, p. ix). I view this discourse as a complement (and sometimes corrective) to scientific psychiatry, offering a bottom-up, client perspective on mental health policy and services.

Additional information

Notes on contributors

Michelle Ciurria

Michelle Ciurria is a postdoctoral researcher in the Department of Philosophy at Washington University in St. Louis.