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The ability to value: An additional criterion for decision-making capacity.

Lauren Harcarik1, Scott Y H Kim2, Joseph Millum3

  • 1School of Social Work, University of Maryland, College Park, Maryland, USA.

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|December 17, 2024
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Summary
This summary is machine-generated.

This study proposes an expanded model for decision-making capacity (DMC) that includes the ability to value alongside cognitive abilities. This approach better respects patient autonomy by focusing on valuing as a skill, not just the content of values.

Keywords:
autonomycapacity assessmentcompetencedecision‐making capacity

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Area of Science:

  • Bioethics
  • Philosophy of Mind
  • Medical Law

Background:

  • The dominant US model for decision-making capacity (DMC) relies on four cognitive abilities: understanding, appreciation, reasoning, and communicating a choice.
  • Critics argue this model is insufficient, neglecting the role of emotions and values in autonomous decision-making.
  • Current proposals for incorporating values into DMC lack consensus and struggle to protect patients with unconventional values.

Purpose of the Study:

  • To propose a refined model of decision-making capacity that integrates the ability to value.
  • To address limitations of the cognitive-centric four abilities model.
  • To provide a framework for respecting patient autonomy, even with unusual values.

Main Methods:

  • Conceptual analysis of the necessary conditions for autonomous decision-making.
  • Development of a new conception of the "ability to value" as a component of DMC.
  • Examination of the components, indicators of impairment, and implications of this ability.

Main Results:

  • The ability to value is proposed as a crucial addition to the traditional four abilities of DMC.
  • The ability to value comprises four components: possession of values, access to values, practical reasoning with values, and acting on reasoned values.
  • This expanded model offers a more robust account of capacity, focusing on the process of valuing.

Conclusions:

  • A comprehensive model of decision-making capacity should include the ability to value.
  • Focusing on the ability to value, rather than the content of values, better supports patient autonomy.
  • This framework provides a new perspective on assessing and understanding decision-making capacity in clinical and ethical contexts.