Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, Maryland, USA.
39 Essex Chambers, London, UK.
J Med Ethics. 2024 Jun 21;50(7):471-475. doi: 10.1136/jme-2023-109199.
All contemporary frameworks of mental capacity stipulate that we must begin from the presumption that an adult has capacity. This presumption is crucial, as it manifests respect for autonomy and guards against prejudice and paternalism on the part of the evaluator.Given its ubiquity, we might presume that we all understand the presumption's meaning and application in the same way. Evidence demonstrates that this is not the case and that this has led to harm in vulnerable persons. There is thus strong reason to question our presumptions about the presumption of capacity.We distinguish between two main ways of understanding and applying the presumption of capacity, and advocate for the one that we argue mitigates risk of harm. Our proposed interpretation offers many advantages in that it is consonant with actual practice of capacity evaluations, precludes confused and abusive avoidance of needed evaluations, and preserves the respect for autonomy motivating the presumption in the first place.
所有当代的精神能力框架都规定，我们必须从假定成年人具有能力开始。这种假定至关重要，因为它体现了对自主性的尊重，并防止了评估者的偏见和家长式作风。鉴于它的普遍性，我们可能会假定我们大家都以同样的方式理解和应用这种假定。有证据表明，事实并非如此，而且这已经导致弱势人群受到伤害。因此，我们有充分的理由质疑我们对能力假定的假定。我们区分了理解和应用能力假定的两种主要方式，并主张我们认为可以减轻伤害风险的那种方式。我们提出的解释有很多优点，因为它符合能力评估的实际做法，避免了对必要评估的混淆和滥用，并且首先保留了促使假定存在的对自主性的尊重。
