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Hidden substance: mental disorder as a challenge to normatively neutral accounts of autonomy

Published online by Cambridge University Press:  19 February 2013

Fabian Freyenhagen  and
Tom O'Shea
Fabian Freyenhagen*
Affiliation:
Essex Autonomy Project, School of Philosophy and Art History, University of Essex
Tom O'Shea
Affiliation:
Essex Autonomy Project, School of Philosophy and Art History, University of Essex
*
[email protected]
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Abstract

Mental capacity and autonomy are often understood to be normatively neutral – the only values or other norms they may presuppose are those the assessed person does or would accept. We show how mental disorder threatens normatively neutral accounts of autonomy. These accounts produce false positives, particularly in the case of disorders (such as depression, anorexia nervosa and schizophrenia) that affect evaluative abilities. Two normatively neutral strategies for handling autonomy-undermining disorder are explored and rejected: a blanket exclusion of mental disorder, and functional tests requiring consistency, expression of identity, reflective non-alienation or lack of compulsion. Finally, we suggest ways in which substantivist alternatives to neutrality can be made more promising through increased transparency, democratic contestability of conditions for capacity and autonomy, and a historically sensitive caution concerning restrictions of liberty.

Type
Articles
Information
International Journal of Law in Context , Volume 9 , Special Issue 1: Mental capacity and value neutrality , March 2013 , pp. 53 - 70
Copyright
Copyright © Cambridge University Press 2013

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References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorder, 4th edn [DSM-IV]. Washington, DC: American Psychiatric Association.Google Scholar
Appelbaum, Paul S. (1998) ‘Ought We to Require Emotional Capacity as Part of Decisional Competence?’, Kennedy Institute of Ethics Journal 8(4): 377–87.Google Scholar
Arneson, Richard J. (1994) ‘Autonomy and Preference Formation’, in Coleman, J. L. and Buchanan, A. (eds.), In Harm's Way: Essays in Honor of Joel Feinberg. Cambridge: Cambridge University Press, Chapter 3.Google Scholar
Bayne, Tim and Levy, Neil (2005) ‘Amputees By Choice: Body Integrity Identity Disorder and the Ethics of Amputation’, Journal of Applied Philosophy 22(1): 75–86.Google Scholar
Benson, Paul (1994) ‘Free Agency and Self-Worth’, Journal of Philosophy 91(12): 650–68.Google Scholar
Benson, Paul (2005) ‘Feminist Intuitions and the Normative Substance of Autonomy’, in Taylor, J. S. (ed.), Personal Autonomy. Cambridge: Cambridge University Press, Chapter 5.Google Scholar
Berofsky, Bernard (1995) Liberation from Self: A Theory of Personal Autonomy. Cambridge: Cambridge University Press.Google Scholar
Bolton, Derek (2008) What Is Mental Disorder? An Essay in Philosophy, Science, and Values. Oxford: Oxford University Press.CrossRefGoogle Scholar
Christman, John (1991) ‘Autonomy and Personal History’, Canadian Journal of Philosophy 21(1): 1–24.Google Scholar
Christman, John (1993) ‘Defending Historical Autonomy: A Reply to Professor Mele’, Canadian Journal of Philosophy 23(2): 281–90.CrossRefGoogle Scholar
Christman, John (1995) ‘Feminism and Autonomy’, in Bushnell, D. E. (ed.), ‘Nagging’ Questions: Feminist Ethics in Everyday Life. Lanham, MD: Rowen & Littlefield, Chapter 2.Google Scholar
Christman, John (2005) ‘Procedural Autonomy and Liberal Legitimacy’, in Taylor, J. S. (ed.), Personal Autonomy: New Essays on Personal Autonomy and its Role in Contemporary Philosophy. Cambridge: Cambridge University Press, Chapter 12.Google Scholar
Christman, John (2009) The Politics of Persons: Individual Autonomy and Socio-historical Selves. Cambridge: Cambridge University Press.Google Scholar
Christman, John (2011) ‘Autonomy in Moral and Political Philosophy’, in Zalta, Edward N. (ed.), Stanford Encyclopedia of Philosophy. Available at: http://plato.stanford.edu/archives/spr2011/entries/autonomy-moral/.Google Scholar
Craigie, Jill (2011) ‘Competence, Practical Rationality and What a Patient Values’, Bioethics 25(6): 326–33.Google Scholar
Dennett, Daniel (1984) Elbow Room: The Varieties of Free Will Worth Wanting. Oxford: Oxford University Press.Google Scholar
Department for Constitutional Affairs (2007) Mental Capacity Act 2005 Code of Practice. London: The Stationery Office.Google Scholar
Dhanda, Amita (2007) ‘Legal Capacity in the Disability Rights Convention: Stranglehold of the Past or Lodestar for the Future?’, Syracuse Journal of International Law and Commerce 34(2): 429–62.Google Scholar
Dworkin, Gerard (1988) The Theory and Practice of Autonomy. Cambridge: Cambridge University Press.Google Scholar
Dworkin, Ronald (1990) ‘Foundations of Liberal Equality’, in Peterson, Grethe B. (ed.), Tanner Lectures On Human Value, Vol. XI. Salt Lake City, UT: University of Utah Press, 1–119.Google Scholar
Feinberg, J. (1989) ‘Autonomy’, in Christman, John (ed.), The Inner Citadel: Essays on Individual Autonomy. Oxford: Oxford University Press, Chapter 2 [reprinted from John Christman (1986) Harm to Self. Oxford: Oxford University Press, Chapter 18].Google Scholar
Fennell, Phil (1996) Treatment Without Consent: Law, Psychiatry and the Treatment of Mentally Disordered People Since 1845. London: Routledge.Google Scholar
Frankfurt, Harry (1971) ‘Freedom of the Will and the Concept of a Person’, Journal of Philosophy 68(1): 5–20.CrossRefGoogle Scholar
Fulford, K. W. M., Broome, M., Stanghellini, G. and Thornton, T. (2005) ‘Looking with Both Eyes Open: Fact and Value in Psychiatric Diagnosis?’, World Psychiatry 4(2): 78–86.Google ScholarPubMed
Grisso, Thomas and Appelbaum, Paul S. (1998) Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals. New York: Oxford University Press.Google Scholar
Grisso, Thomas and Appelbaum, Paul S. (2006) ‘Appreciating Anorexia: Decisional Capacity and the Role of Values’, Philosophy, Psychiatry, & Psychology 13(4): 293–97.Google Scholar
Law Commission (1991) Consultation Paper No. 119: Mentally Incapacitated Adults and Decision-Making: An Overview. London: HMSO.Google Scholar
Mill, John S. (1991 [1859]) ‘On Liberty’, in Gray, J. (ed.), John Stuart Mill: On Liberty and Other Essays. Oxford: Oxford University Press, 1–128.Google Scholar
Niesen, Peter (2004) ‘Anti-extremism, Negative Republicanism, Civic Society: Three Paradigms for Banning Political Parties,’ in Zumbansen, Peer and Miller, Russell A. (eds), Annual of German and European Law 2003. Oxford: Berghahn, 81–112.Google Scholar
Oshana, Marina (1998) ‘Personal Autonomy and Society’, Journal of Social Philosophy 29(1): 81–102.Google Scholar
Owen, Gareth S., Freyenhagen, Fabian, Genevra, Richardson and Hotopf, Matthew (2009) ‘Mental Capacity And Judgmental Autonomy: An Decisional Challenge’, Inquiry 52(1): 79–107.Google Scholar
Owen, Gareth S., Cutting, John and David, Anthony S. (2007) ‘Are People with Schizophrenia More Logical than Healthy Volunteers?’, British Journal of Psychiatry 191: 453–54.CrossRefGoogle ScholarPubMed
Pettit, Philip (1997) Republicanism: A Theory of Freedom and Government. New York: Oxford University Press.Google Scholar
Pettit, Philip (2001) A Theory of Freedom: From the Psychology to the Politics of Agency. New York: Oxford University Press.Google Scholar
Rawls, John (1996) Political Liberalism. New York: Columbia University Press.Google Scholar
Richardson, Genevra (2010) ‘Mental Capacity at the Margins: The Interface between Two Acts’, Medical Law Review 18: 56–77.Google Scholar
Sadler, John Z. (ed.) (2002) Descriptions and Prescriptions: Values, Mental Disorders, and the DSMs. Baltimore: Johns Hopkins University Press.Google Scholar
Sadler, John Z. (2004) Values and Psychiatric Diagnosis. Oxford: Oxford University Press.CrossRefGoogle Scholar
Sen, Amartya (2009) The Idea of Justice. London: Allen Lane.Google Scholar
Szasz, Thomas (1970) ‘Involuntary Mental Hospitalization: A Crime Against Humanity’, in Szasz, Thomas, Ideology and Insanity: Essays on the Psychiatric Dehumanization of Man. London: Calder & Boyars, 113–39.Google Scholar
Tan, Jacinta O. A., Hope, Tony, Stewart, Anne and Fitzpatrick, Raymond (2006) ‘Competence to Make Treatment Decisions in Anorexia Nervosa: Thinking Processes and Values’, Philosophy, Psychiatry, & Psychology 13(4): 267–82.Google Scholar
Tan, Jacinta O. A., Stewart, Anne and Hope, Tony (2009) ‘Decision-making as a Broader Concept’, Philosophy, Psychiatry, & Psychology 16(4): 341–44.Google Scholar
Velleman, David (1999) ‘A Right to Self-Termination?’, Ethics 109(3): 606–628.CrossRefGoogle ScholarPubMed
Wakefield, Jerome C. (1992) ‘The Concept of Mental Disorder: On the Boundary Between Biological Facts and Social Values’, American Psychologist 47(3): 373–88.Google Scholar
Who (1991) The ICD-10 Classification of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines [ICD-10]. Geneva: World Health Organisation.Google Scholar
Wilson, Derek (2007) Out of the Storm: The Life and Legacy of Martin Luther. London: Random House.Google Scholar
Wolf, Susan (1989) ‘Sanity and the Metaphysics of Responsibility’, in Christman, John (ed.), The Inner Citadel: Essays on Individual Autonomy. Oxford: Oxford University Press, Chapter 9 [reprinted from F. Schoeman (ed.) (1987), Responsibility, Character, and the Emotions. Cambridge: Cambridge University Press, Chapter 3].Google Scholar
Wolf, Susan (1990) Freedom Within Reason. Oxford: Oxford University Press.Google Scholar