The Cognitive Based Approach of Capacity Assessment in Psychiatry: A Philosophical Critique of the MacCAT-T [Book Review]

Health Care Analysis 12 (4):273-283 (2004)
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Abstract

This article gives a brief introduction to the MacArthur Competence Assessment Tool-Treatment (MacCAT-T) and critically examines its theoretical presuppositions. On the basis of empirical, methodological and ethical critique it is emphasised that the cognitive bias that underlies the MacCAT-T assessment needs to be modified. On the one hand it has to be admitted that the operationalisation of competence in terms of value-free categories, e.g. rational decision abilities, guarantees objectivity to a great extent; but on the other hand it bears severe problems. Firstly, the cognitive focus is in itself a normative convention in the process of anthropological value-attribution. Secondly, it misses the complexity of the decision process in real life. It is therefore suggested that values, emotions and other biographic and context specific aspects should be considered when interpreting the cognitive standards according to the MacArthur model. To fill the gap between cognitive and non-cognitive approaches the phenomenological theory of personal constructs is briefly introduced. In conclusion some main demands for further research to develop a multi-step model of competence assessment are outlined

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Citations of this work

Decision-making capacity.Louis Charland - 2011 - Stanford Encyclopedia of Philosophy.
Unreasonable reasons: normative judgements in the assessment of mental capacity.Natalie F. Banner - 2012 - Journal of Evaluation in Clinical Practice 18 (5):1038-1044.
Do we need a threshold conception of competence?Govert den Hartogh - 2016 - Medicine, Health Care and Philosophy 19 (1):71-83.
Decision-Making Capacity.Jennifer Hawkins & Louis C. Charland - 2020 - Stanford Encyclopedia of Philosophy.

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References found in this work

Deciding for Others: The Ethics of Surrogate Decision Making.Allen E. Buchanan & Dan W. Brock - 1989 - New York: Cambridge University Press. Edited by Dan W. Brock.
The Many Faces of Competency.James F. Drane - 2012 - Hastings Center Report 15 (2):17-21.
Ought we to require emotional capacity as part of decisional competence?Paul S. Appelbaum - 1998 - Kennedy Institute of Ethics Journal 8 (4):377-387.

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