The contribution of narrative ethics to issues of capacity in psychiatry

Cognitive and rational assessments of competence do not fully capture the way in which individuals normally make decisions. Human beings have always used stories to explain their experiences and values. Narrative ethics should be used to understand the perspective in context of a patient whose competence is in question, and so avoid a destructive clash. Psychiatry and professionals within it also have a narrative that may join with that of science, but there is no special privilege for these narratives unless survival is at stake. The narrative approach should be used to try to make different stories compatible. This article examines the background to this approach, and indicates some ways in which it could be used in the specific cases addressed in the series.