Ulysses in the United Kingdom: Difficulties with a capacity-based justification for self-binding in bipolar disorder.

  • Nuala B Kane
  • Published 2017 in Journal of evaluation in clinical practice

Abstract

There has been a recent proposal by Gergel and Owen for introduction of legally enforceable self-binding directives for persons with bipolar affective disorder in the United Kingdom. The model is rooted in presence or absence of decision-making capacity, and the notion of capacity used is an expansion of the usual notion of capacity, in that it is individualized and diachronic. In this article, I argue that an individualized notion of capacity either lacks a coherent foundation or exposes itself to a situation where epistemological error results in a double standard or unjustified enforcement of the directive. I also raise concern that the diachronic notion of capacity leads to an authenticity type account, which fails to incorporate differences in individual prognosis. I then present a rough sketch of an alternative account, more in keeping with current mental health legislation, which uses an individualized notion of "risk to self" to justify self-binding directives in bipolar disorder.

DOI: 10.1111/jep.12809

Cite this paper

@article{Kane2017UlyssesIT, title={Ulysses in the United Kingdom: Difficulties with a capacity-based justification for self-binding in bipolar disorder.}, author={Nuala B Kane}, journal={Journal of evaluation in clinical practice}, year={2017}, volume={23 5}, pages={1038-1044} }