Hyslop Brent
Bioethics Centre, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
J Bioeth Inq. 2017 Sep;14(3):439-444. doi: 10.1007/s11673-017-9795-8. Epub 2017 Jun 20.
Decision-making capacity is a vital concept in law, ethics, and clinical practice. Two legal cases where capacity literally had life and death significance are NHS Trust v Ms T [2004] and Kings College Hospital v C [2015]. These cases share another feature: unusual beliefs. This essay will critically assess the concept of capacity, particularly in relation to the unusual beliefs in these cases. Firstly, the interface between capacity and unusual beliefs will be examined. This will show that the "using and weighing of information" is the pivotal element in assessment. Next, this essay will explore the relationship between capacity assessment and a decision's "rationality." Then, in light of these findings, the essay will appraise the judgments in NHS v T and Kings v C, and consider these judgments' implications. More broadly, this essay asks: Does capacity assessment examine only the decision-making process (as the law states), or is it also influenced by a decision's rationality? If influenced by rationality, capacity assessment has the potential to become "a search and disable policy aimed at those who are differently orientated in the human life-world" (Gillett 2012, 233). In contentious cases like these, this potential deserves attention.
决策能力是法律、伦理和临床实践中的一个重要概念。在NHS信托诉T女士案[2004]和国王学院医院诉C案[2015]这两个法律案件中，能力实际上具有生死攸关的意义。这些案件还有另一个特点：存在不同寻常的信念。本文将批判性地评估能力的概念，特别是与这些案件中不同寻常的信念相关的方面。首先，将审视能力与不同寻常信念之间的关系。这将表明，“对信息的运用和权衡”是评估中的关键要素。接下来，本文将探讨能力评估与决策“合理性”之间的关系。然后，根据这些研究结果，本文将评价NHS诉T案和国王学院医院诉C案的判决，并考虑这些判决的影响。更广泛地说，本文提出：能力评估仅仅是审查决策过程（如法律所述），还是也受决策合理性的影响？如果受合理性影响，能力评估有可能成为“一项针对那些在人类生活世界中有着不同取向的人的搜寻和使能政策”（吉列特，2012年，第233页）。在诸如此类有争议的案件中，这种可能性值得关注。
