Kane Nuala B
Department of Psychological Medicine, King's College Hospital, South London and Maudsley NHS Foundation Trust, London, UK.
J Eval Clin Pract. 2017 Oct;23(5):1038-1044. doi: 10.1111/jep.12809.
There has been a recent proposal by Gergel and Owen for introduction of legally enforceable self-binding directives for persons with bipolar affective disorder in the United Kingdom. The model is rooted in presence or absence of decision-making capacity, and the notion of capacity used is an expansion of the usual notion of capacity, in that it is individualized and diachronic. In this article, I argue that an individualized notion of capacity either lacks a coherent foundation or exposes itself to a situation where epistemological error results in a double standard or unjustified enforcement of the directive. I also raise concern that the diachronic notion of capacity leads to an authenticity type account, which fails to incorporate differences in individual prognosis. I then present a rough sketch of an alternative account, more in keeping with current mental health legislation, which uses an individualized notion of "risk to self" to justify self-binding directives in bipolar disorder.
最近，格尔格尔和欧文提议在英国为双相情感障碍患者引入具有法律强制力的自我约束指令。该模式基于决策能力的有无，所采用的能力概念是对通常能力概念的扩展，因为它是个性化的且具有历时性。在本文中，我认为个性化的能力概念要么缺乏连贯的基础，要么使自身陷入一种认识论错误导致双重标准或指令执行不合理的情况。我还担心能力的历时性概念会导致一种真实性类型的解释，这种解释未能纳入个体预后的差异。然后，我提出了一个大致的替代解释框架，它更符合当前的心理健康立法，该框架使用个性化的“自我风险”概念来证明双相情感障碍中的自我约束指令是合理的。
