Defending manic competence: a reply to Kane

In a recent paper in this journal, I defended the thesis that some, although not all, patients experiencing acute bipolar mania are competent to consent. I made this argument based on the fact that the burden of proof lies with those who want to make judgements of incapacity (because autonomy is the default option until proven otherwise). We then need to ask what the reasons are for claiming that manic patients are not competent. I surveyed and critiqued the two most common reasons offered in the literature, which are that manic patients are irrational or that their value shifts in mania are defunct in some way. I argued that for many manic patients, neither of these reasons is strong enough to justify removing their decision-making capacity. Kane (2024) replied to my paper. In this short response, I defend my original arguments from Kane's objection.