Harmful Choices, the Case of C, and Decision-Making Competence

• Published in: American journal of bioethics Vol. 22; no. 10; pp. 38 - 50
• Main Authors: Pickering, Neil, Newton-Howes, GIles, Young, Greg
• Format: Journal Article
• Language: English
• Published: Taylor & Francis 03.10.2022
• Subjects: Decision making; law; medicine; philosophy; professional-patient relationship
• ISSN: 1526-5161; 1536-0075
• DOI: 10.1080/15265161.2021.1941422

In this paper, we make the case that a person who is considering or has already made a decision that appears seriously harmful to that person should in some cases be judged incapable of making that decision because of the harmfulness of the decision. We focus on the English case of C of 2015. C refused life-saving dialysis. The hospital wanted her declared incompetent to make this decision under the English Mental Capacity Act of 2005. The Judge argued that the consequences for a person's welfare of their decision are irrelevant to the assessment of competence, a position labeled "internalism." This aligns with an assessment of decision-making competence on a strictly cognitivist model. However, internalism misrepresents decision-making. The outcomes of decision-making processes should be part and parcel of judgments of decision-making competence, and in some cases are necessary for any judgment of incompetence to be made.