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Ulysses in the United Kingdom: Difficulties with a capacity-based justification for self-binding in bipolar disorder

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Original languageEnglish
Pages (from-to)1038-1044
Number of pages7
JournalJournal of Evaluation in Clinical Practice
Volume23
Issue number5
DOIs
Published1 Oct 2017

King's Authors

Abstract

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.

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