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A civic republican analysis of mental capacity law

Published online by Cambridge University Press:  03 April 2018

Tom O'Shea*
Affiliation:
University of Roehampton
*
*Author email: [email protected]

Abstract

This paper draws upon the civic republican tradition to offer new conceptual resources for the normative assessment of mental capacity law. The republican conception of liberty as non-domination is used to identify ways in which such laws generate arbitrary power that can underpin relationships of servility and insecurity. It also shows how non-domination provides a basis for critiquing legal tests of decision making that rely upon ‘diagnostic’ rather than ‘functional’ criteria. In response, two main civic republican strategies are recommended for securing freedom in the context of the legal regulation of psychological disability: self-authorisation techniques and participatory shaping of power. The result is a series of proposals for the reform of decisional capacity law, including a transition towards purely functional assessment of decisional capacity, surer legal footing for advanced care planning, and greater control over the design and administration of decision making capacity laws by those with psychological disabilities.

Type
Research Article
Copyright
Copyright © The Society of Legal Scholars 2018 

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Footnotes

I would like to thank Lucy Series, Wayne Martin, and two anonymous reviewers for their constructive comments on earlier versions of this paper. Department of Humanities, University of Roehampton, London, United Kingdom, SW15 5PU.

References

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3 UN General Assembly, Convention on the Rights of Persons with Disabilities, 13 December 2006, Art 12.

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8 More precisely, we might say that the possible use of legal capacity presupposes mental capacity in these cases, since some have argued that legal capacity can be held by someone and exercised for them by another they have previously appointed to do so, even when they cannot directly use it themselves. For discussion, see Bieby, PThe conflation of competence and capacity in English medical law: a philosophical critique’ (2005) 8 Medicine, Health Care, and Philosophy 357Google Scholar.

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15 Quinn, above n 14, p 93.

16 Bach and Kerzner, above n 6, p 60.

17 Ibid, p 66.

18 Ibid: ‘This minimum threshold of human agency we might characterize as: to act in a way that at least one other person who has personal knowledge of an individual can reasonably ascribe to one's actions, personal will and/or intentions, memory, coherence through time, and communicative abilities to that effect.’ Furthermore, even if decisions are made for others in their best interest on this basis, Bach and Kerzner claim that such a ‘facilitated status would not define them as being “legally incapable”’: Bach and Kerner, above n 6, p 92.

19 Ibid, p 40.

20 Quinn, GRethinking personhood: new directions in legal capacity law & policy’ in Centre for Disability Law and Policy, Submission on Legal Capacity to the Oireachtas Committee on Justice, Defence & Equality (Galway: NUI Galway, 2011) p 54Google Scholar.

21 Bach and Kerzner, above n 6, pp 38–44.

22 Mental Capacity Act 2005 s 1(6).

23 Ibid, s 1(3).

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28 However, see the debates in Laborde, C and Maynor, J (eds) Republicanism and Political Theory (Oxford: Blackwell, 2008)Google Scholar part I. For a response from a civic republican approach to disability, see O’Shea ‘Disability and domination', above n 4, pp 138–40.

29 Pettit, above n 4, p 71.

30 Mental Capacity Act 2005 s 3(1). Similarly, the landmark MacArthur study of decision making competence of patients in state law in the US has identified four related (albeit not identical) necessary conditions for decision making capacity: ‘understanding information relevant to their condition and the recommended treatment, reasoning about the potential risks and benefits of their choices, appreciating the nature of their situation and the consequences of their choices, and expressing a choice.’ Grisso, T, Appelbaum, P and Hill-Fotouhi, CThe MacCAT-T: a clinical tool to assess patients’ capacities to make treatment decisions’ (1997) 48 Psychiatric Services 1415Google ScholarPubMed. See also the presentation of the legal and clinical results of the MacArthur study in Grisso, T and Appelbaum, P Assessing Competence to Consent to Treatment: A Guide for Physicians and Other Health Professionals (Oxford: Oxford University Press, 1998)Google Scholar.

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35 Mental Capacity Act 2005 s 2(1).

36 Law Commission Consultation Paper 128, Mentally Incapacitated Adults and Decision-Making – A New Jurisdiction (London: HMSO, 1993) para 3.11.

37 Dhanda, above n 2, p 445.

38 Laborde, above n 27, p 11.

39 Thematic Study by the Office of the United Nations High Commissioner for Human Rights on enhancing awareness and understanding of the Convention on the Rights of Persons with Disabilities, A/HRC/10/48 (26 January 2009), para 49.

40 For concerns about such reversion, see Dhanda, above n 2, p 445.

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43 Redley, M, Hughes, J and Holland, AVoting and mental capacity’ (2010) 341 BMJ 466CrossRefGoogle ScholarPubMed. For more extensive disqualification of voters on the grounds of mental disorder or incompetence in some US states, see Appelbaum, P“I vote. I count”: mental disability and the right to vote’ (2000) 51 Psychiatric Services 849CrossRefGoogle ScholarPubMed.

44 On the limits to their use, see Jox, R, Michalowski, S, Lorenz, J and Schildmann, JSubstitute decision making in medicine: comparative analysis of the ethico-legal discourse in England and Germany’ (2008) 11 Medicine, Health Care and Philosophy 153154CrossRefGoogle ScholarPubMed.

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46 For such an underspecified appeal to relational autonomy, see Bach and Kerzner, above n 6, p 40. Hierarchical accounts of autonomy are also not well placed to explain why advanced care planning enhances freedom, since they ascribe autonomy to a synchronic psychological relationship (such as one between desires and volitions). Respecting the wishes of the earlier self or otherwise giving it control over the social environment of the current self does not secure the appropriate concurrent psychological relationships in which autonomy is located.

47 Pettit offers an example with the same pre-authorisation structure: ‘If I allow you to keep the liquor cabinet key or to hide my cigarettes, you still interfere with me when you act under that permission. But your interference will not be control or domination; the interference will be controlled or nonarbitrary.’ Pettit, PA republican right to basic income?’ (2007) 2 Basic Income Studies 6Google Scholar.

48 Bach and Kerzner, above n 6, p 91.

49 Ibid, p 93.

50 Flynn and Arstein-Kerslake, above n 14, p 99. See also the discussion of ‘serious adverse effects’ in Bach and Kerzner, above n 6, pp 130–158.

51 Arendt, H The Origins of Totalitarianism: New Edition with Added Prefaces (San Diego, CA: Harcourt Brace & Company, 1973) p 447Google Scholar.

52 Ibid, pp. 296, 298.

53 Ibid, p 301.

54 Balibar, ÉWhat is a politics of the rights of man?’ in Swenson, J (ed) Masses, Classes, Ideas: Studies on Politics and Philosophy Before and After Marx (London: Routledge, 1994) p 213Google Scholar.

55 Hamilton, L Freedom is Power: Liberty Through Political Representation (Cambridge: Cambridge University Press, 2014) p 52CrossRefGoogle Scholar.

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58 Pettit, above n 41, p 260.

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60 Pettit, above n 4, p 83. For a republican rejoinder, see Honohan, above n 4, p 186.

61 Gourevitch, above n 56, p 183.

62 For further discussion of the relationship between domination and usurpation of agency, see Markell, PThe insufficiency of non-domination’ (2008) 36 Political Theory 9CrossRefGoogle Scholar.