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15 - Mental Health and Mental Capacity

Published online by Cambridge University Press:  24 August 2009

S. A. M. McLean
Affiliation:
University of Glasgow
J. K. Mason
Affiliation:
University of Edinburgh
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Summary

There can be few areas in medicine where the conflict of ethical principles is exposed so starkly as it is in respect of the management of mental ill health. We have seen throughout this book that autonomy of the individual – that is, the right to make choices and to control what is done with one's body – has become the cornerstone of modern medical ethics. Yet, by definition, the person with mental disorder cannot make ordered decisions and, in the extreme position, someone must act on his or her behalf – this is, in short, paternalism, a concept which is now generally regarded as both outmoded and undesirable but which returns, in this context, as an acceptable, and in some cases an unavoidable, option.

The solution to the resulting problem is not, however, of the all or nothing variety. A person's mental disorder may be permanent, temporary or fluctuating; it may be severe or it may be minor; it may interfere with one form of mental activity but not with another. Put another way, mental disorder will interfere with the patient's capacity to make autonomous decisions to a variable extent and the degree of acceptable paternalistic intervention on his or her behalf varies directly with the degree of incapacity. This leads us to a succession of questions. How far can we respect the residual autonomy of someone with only partial capacity? Who is going to decide the patient's capacity in the prevailing circumstances?

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Publisher: Cambridge University Press
Print publication year: 2003

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