The values and rules of capacity assessments

Area of Science:

• Clinical Ethics
• Medical Law
• Philosophy of Medicine

Background:

• Current clinical assessments of decision-making capacity often strive for value-neutrality.
• The prevailing four abilities model in common law countries is frequently presented as value-neutral.
• This value-neutrality is challenged as both rationally impossible and practically detrimental.

Purpose of the Study:

• To critically examine the role of evaluative judgment in clinical decision-making capacity assessments.
• To argue against the feasibility and desirability of excluding patient values from capacity evaluations.
• To propose an alternative evaluative model for capacity assessment.

Main Methods:

• Philosophical argumentation regarding the nature of judgment and values in clinical assessment.
• Analysis of the limitations and negative consequences of the prevailing four abilities model.
• Conceptual development of a value-explicit model for capacity assessment.

Main Results:

• It is rationally impossible to exclude a patient's values from capacity assessments.
• Excluding patient values leads to intractable dilemmas and patient harm.
• The four abilities model's claim to value-neutrality is inaccurate and problematic.

Conclusions:

• Clinical capacity assessments must incorporate evaluative judgments of patient values.
• A straightforward evaluative model, explicitly addressing values and 'serious prudential mistakes,' is superior.
• This revised approach avoids the rational and practical problems associated with value-neutral models.