What renders some mentally disordered patients incapable of informed consent to medical interventions? It is argued that a patient is incapable of giving informed consent owing to mental disorder, if a mental disorder prevents a patient from understanding what s/he consents to; if a mental disorder prevents a patient from choosing decisively; if a mental disorder prevents a patient from communicating his/her consent; or if a mental disorder prevents a patient from accepting the need for a medical intervention. This paper (...) holds that a patient's capacity to give informed consent should be assessed clinically by using these conditions necessary for informed consent, and should be assessed specifically for each intervention and specifically at the time when the consent has to be given. The paper considers patients' incapacity to give informed consent to treatment, to give informed consent to be examined clinically, and to give informed consent to participate in research. (shrink)

This paper presents the philosophical theory underpinning an empirical study that found changes in the semantic usage of first person pronouns by recovering psychotherapy patients. The philosophical theory provided semantic variables that could serve as markers of recovery. It derived from the semantic theory by Gottlob Frege and the logic of relations, and accounts for the meaning expressed by the first person pronouns as distinct from their syntax and pragmatic symbolization. This distinction is worthwhile because empirical evidence was found for (...) change in the meaning expressed by these pronouns during recovery, but not for change in their syntax or pragmatic symbolization. Philosophical work on the concepts of illness and recovery was used to deduce that the semantic variables are markers of recovery in general rather than in psychotherapy only. As with the empirical study, the semantic variables were shown to change as follows when someone recovers: occupancy of alpha positions is taken up and occupancy of omega positions is relinquished. Potential applications of these findings were examined by which the tracking of the semantic variables may serve to improve the clinician's understanding of a patient, monitor a patient's progress, and enhance recovery. (shrink)

This chapter outlines the origins in ordinary language philosophy of a new skills-based approach to working with complex and conflicting values in medicine called values-based practice. Ordinary language philosophy focuses on our use of words as a useful first step in coming to a more complete understanding of their meanings. The theory of values-based practice was developed by applying ideas from ordinary language philosophy to the long-running debate about the "boundary problem" presented by the concept of mental disorder. Ordinary language (...) philosophy turns this debate topsy-turvy: it shows, that the concept of mental disorder instead of being the target problem is a resource for coming to a more complete understanding of the meanings of concepts of disorder as a whole including the concept of bodily disorder; and correspondingly, that the value-laden nature of mental disorder far from being part of the problem points to an evaluative element of meaning in concepts of disorder as a whole, again including concepts of bodily disorder. It is these topsy-turvy results that underpin the development of values-based practice. In a brief concluding section we indicate the potential for further development of values-based practice supported by ordinary language and other philosophies particularly through engagement with non-Western language groups representing diverse traditions of thought and practice in mental health. (shrink)

THE FIRST PART OF MY RESPONSE to the commentaries on my earlier paper is about the place of language and logical systems in the understanding of the personal positions that recovering patients occupy in their life experiences. It includes the main reasons for using Frege's philosophy. Thereafter, I make the point that relational positions in recovery extend broader than positions of actor and patient.