This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum’s capabilities approach and Fulford’s and Fulford et al ’s values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based practice. The article points out (...) that both Nussbaum’s approach and values-based practice recognise that people’s values differ. The idea of involving different actors and service users in mental healthcare is also common in both Nussbaum’s approach and values-based practice. However, there are also differences in that values-based practice relies on a ‘good process’ in decision-making, whereas the capabilities approach is oriented towards a ‘right outcome’. However, since process and outcome are linked with each other, these two approaches do not necessarily conflict despite this difference. The article suggests that absolute rights are possible within the two approaches. It also recognises that the capabilities approach, values-based practice and human rights approach lean on liberal values and thus can be combined at least in liberal societies. (shrink)

Human rights theory generally conceptualizes freedom of thought, conscience, religion, and belief as well as freedom of opinion and expression, as offering absolute protection in what is called the forum internum. At a minimum, this is taken to mean the right to maintain thoughts in one’s own mind, whatever they may be and independently of how others may feel about them. However, if we adopt this stance, it seems to imply that there exists an absolute right to hold psychotic delusions. (...) This article takes the position that this conclusion is ethically problematic from the perspective of psychiatric treatment and the rights of persons with psychosis. The article reflects on this particular challenge and sets forth an understanding of freedom in the forum internum that might apply to situations where for various reasons it is not, necessarily accurate to maintain that persons have an absolute right to their own thoughts. For the purpose of proposing such an understanding, the article engages with current debates within human rights theory and political philosophy and analyzes discussions about psychotic delusions and the way in which involuntary treatment is justified. Based on this analysis, this article in turn conceptualizes freedom in the forum internum as ‘negative liberty’, ‘authenticity’, and ‘capability’. This article suggests that when forum internum is redefined as encompassing a right to certain internal capabilities, the right remains meaningful for persons with psychotic delusions as well. (shrink)