Pickering et al. argue that judgments of competence should in part be based on the harm that could result from the decision. The centerpiece of their reasoning is that it is inconsistent...

McCarthy and Howard (2023) present a “Non-Domination” approach to supported decision-making, specially to help intellectually and developmentally disabled (IDD) patients rather than “Mental Prosthe...

Over the course of human life, health care decision‐making is often interdependent. In this article, we use “interdependence” to refer to patients’ engagement of nonclinicians—for example, family members or trusted friends—to reach health care decisions. Interdependence, we suggest, is common for patients in all stages of life, from early childhood to late adulthood. This view contrasts with the common bioethical assumption that medical decisions are either wholly independent or dependent and that independence or dependence is tightly coupled with a person's (...) decision‐making capacity. In this article, we array various approaches to decision‐making along a continuum of interdependence. An appreciation of this continuum can empower patients and elucidate ethical challenges that arise when people transition between different kinds of interdependence across the life span. (shrink)

McCarthy and Howard (2023) develop an ethical case for supported decision-making in medical contexts, mainly building upon the republican ideal of non-domination. Their theoretical inquiry is of mu...

Decision-making capacity (DMC) plays an important role in clinical practice—determining, on the basis of a patient’s decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it’s critical that we get things right—that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts about (...) who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine tuning—variations of the standard approach cannot adequately address them. Instead, we should ditch DMC. (shrink)

We join McCarthy and Howard (2023) in advocating supported decision-making for patients with diminished mental capacity that meaningfully expands the role of trustees beyond merely channeling the i...

Medical decision-making on behalf of intellectually and developmentally disabled (IDD) patients amounts to a critical challenge, one which has been widely discussed by bioethicists, medical, and le...

The mental prosthesis model (Silvers and Francis 2009) suggests that interpersonal “prosthetic” thinking could support decision making for people with limited cognitive capacities, and positions th...