The values and rules of capacity assessments

Journal article

This article advances two views on the role of evaluative judgment in clinical assessments of decision-making capacity. The first is that it is rationally impossible for such assessments to exclude judgments of the values a patient uses to motivate their decision-making. Predictably, and second, attempting to exclude such judgments sometimes yields outcomes that contain intractable dilemmas that harm patients. These arguments count against the prevailing model of assessment in common law countries-the four abilities model-which is often incorrectly advertised as being value-neutral in respect of patient decision-making both by its proponents and in statute. A straightforward evaluative model of capacity assessment which wears its values on its sleeves and is biased against what are called 'serious prudential mistakes' avoids these rational and practical problems.

Authors: Hass, B

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: BMJ Publishing Group
• Journal: Journal of Medical Ethics
• Volume: 48
• Issue: 11
• Pages: 816-820
• Publication date: 2022-02-23
• Acceptance date: 2022-01-24
• DOI: 10.1136/medethics-2021-107923
• EISSN: 1473-4257
• ISSN: 0306-6800
• Pmid: 35197300
• Language: English
• Keywords: informed consent; FFR; personal autonomy; capacity