Ulysses in the United Kingdom: Difficulties with a capacity-based justification for self-binding in bipolar disorder

作者：Kane Nuala B^*

来源：Journal of Evaluation in Clinical Practice, 2017, 23(5): 1038-1044.

DOI：10.1111/jep.12809

• bipolar affective disorder
• decision-making capacity
• identity
• medical ethics
• philosophy of medicine
• psychiatry
• risk
• self-binding directives

There has been a recent proposal by Gergel and Owen for introduction of legally enforceable self-binding directives for persons with bipolar affective disorder in the United Kingdom. The model is rooted in presence or absence of decision-making capacity, and the notion of capacity used is an expansion of the usual notion of capacity, in that it is individualized and diachronic. In this article, I argue that an individualized notion of capacity either lacks a coherent foundation or exposes itself to a situation where epistemological error results in a double standard or unjustified enforcement of the directive. I also raise concern that the diachronic notion of capacity leads to an authenticity type account, which fails to incorporate differences in individual prognosis. I then present a rough sketch of an alternative account, more in keeping with current mental health legislation, which uses an individualized notion of risk to self to justify self-binding directives in bipolar disorder.

• 出版日期2017-10