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...

The freedom to choose for oneself is a part of what it means to be a human being.Jackson J In England and Wales, the Mental Capacity Act 20...

In this thoughtful article analyzing a UK court decision upholding a patient’s refusal of dialysis, the authors make the provocative but ultimately unpersuasive argument tha...

In “Harmful Choices, the case of C, and decision making competence,” Pickering et al. offer a thought-provoking interpretation of the relationship between harm and capacity assessments by an...

The dominant approach to assessing decision-making capacity in medicine focuses on determining the extent to which individuals possess certain core cognitive abilities. Critics have argued that this model delivers the wrong verdict in certain cases where patient values that are the product of mental disorder or disordered affective states undermine decision-making without undermining cognition. I argue for a re-conceptualization of what it is to possess the capacity to make medical treatment decisions. It is, I argue, the ability to track one’s (...) own personal interests at least as well as most people can. Using this idea, I demonstrate that it is possible to craft a solution for the problem cases—one that neither alters existing criteria in dangerous ways (e.g. does not open the door to various kinds of abuse) nor violates the spirit of widely accepted ethical constraints on decision-making assessment. (shrink)

In “Harmful Choices, the Case of C, and Decision-Making Competence,” Pickering and colleagues advance an argument in favor of externalism, a view in which the competence of a decision maker is judged relative to factors external to their cognition. In advancing this argument, Pickering and colleagues focus on the external factor of harm: In their view, it is the harmfulness of a considered or chosen action that provides evidence against the competence of the decision maker. However, the proper identification of (...) harmful choices and outcomes remains a demanding task, largely because our understanding of what harm is remains deeply incomplete. Despite 50 years of tempestuous debate, the metaphysics of harm remains an unsettled question. The existence of such a debate does not, in and of itself, provide evidence against the externalist position; rather, it is the theories of harm themselves that pose meaningful challenges for the externalist. Our purpose, here, is to illuminate these challenges. (shrink)

Pickering, Newton-Howes, and Young argue for externalism about competence—the view that “welfare judgments are part of judgments about competence” and posit an “explanatory connection” betwe...

According to Pickering, Newton-Howes, and Young, the harmfulness of decisions does, and should, factor into determining patients' decisional competence. As they claim, decision-making proces...

Pickering et al. argue that patients who refuse doctor-recommended treatments should in some cases be deemed incompetent to decide about their own medical care—in part because of their decis...

In this Open Peer Commentary, we draw on our clinical experience to argue that instrumental paternalism carves a pathway to competent refusal of medical intervention. Whether C successfully navigat...

Pickering, Newton-Howes, and Young argue that a person should be considered incapable of making a specific decision if that decision is judged by onlookers to be seriously harmful to the dec...

Pickering, Newton-Howes, and Young argue for an externalist view on assessing decision-making capacity. Pickering, Newton-Howes, and Young argue the harmful consequences of a person’s...

In their article, Pickering, Newton-Howes, and Young argue that “a person who is considering or has already made a decision which appears seriously harmful to that person should in some case...