Problems of Control: Alcohol Dependence, Anorexia Nervosa, and the Flexible Interpretation of Mental Incapacity Tests
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This article investigates the ability of mental incapacity tests to account for problems of control, through a study of the approach to alcohol dependence and a comparison with the approach to anorexia nervosa, in England and Wales. The focus is on two areas of law where questions of legal and mental capacity arise for people who are alcohol dependent: decisions about treatment for alcohol dependence and diminished responsibility for a killing. The mental incapacity tests used in these legal contexts are importantly different-one involves a 'cognitive' test, while the other includes an explicit impaired-control limb-and the comparison provides insight into a longstanding debate about the virtues of one type of test over the other. It is shown that both kinds of test can take control problems into account, but also that both can be interpreted in narrow and wide ways that significantly influence the outcome of the assessment. It is therefore argued that to a large extent, it is not the kind of mental incapacity test that matters, but how the test is interpreted. It is further proposed that value judgements are playing an unrecognised and inappropriate role in shaping this interpretation. This raises concerns about the current approach to assessing the impact of alcohol dependency on the capacity to make decisions about alcohol use or treatment, as well as broader concerns about flexibility within incapacity tests.
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We and others take issue with the sweeping assertion that patients with anorexia nervosa lack capacity for medical decision-making.
“We and others (e.g. [28, 29]), take issue with the sweeping assertion that patients with AN lack capacity for medical decision-making.”
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Cites
Representativeness revisited: Attribute substitution in intuitive judgment.
Kahneman, D., & Frederick, S. (2002) · Heuristics and Biases · doi:10.1017/cbo9780511808098.004 · Cited by 3,476 · cited 1× · see citing works
“143 It is proposed here that such evaluative and other social inputs—for example, gender stereotypes—play a significant role in explaining the differences observed between the approach to assessing mental capacity in the context of alcohol dependency and anorexia.”
BackgroundThe discovery of addiction. Changing conceptions of habitual drunkenness in America.
Levine, H. G. (1978) · Journal of Studies on Alcohol · doi:10.15288/jsa.1978.39.143 · Cited by 686 · see citing works
Competence to Make Treatment Decisions in Anorexia Nervosa: Thinking Processes and Values
Tan, J. O. A., Stewart, A., Fitzpatrick, R. M., & Hope, R. A. (2006) · Philosophy, psychiatry & psychology · doi:10.1353/ppp.2007.0032 · Cited by 247 · cited 1× · see citing works
“46 In the case law both before and after the implementation of the MCA, impaired control is a central feature of anorexia held relevant to questions concerning the capacity make decisions about treatment.”
BackgroundADDICTION AND AUTONOMY: CAN ADDICTED PEOPLE CONSENT TO THE PRESCRIPTION OF THEIR DRUG OF ADDICTION?
Foddy, B., & Savulescu, J. (2005) · Bioethics · doi:10.1111/j.1467-8519.2006.00470.x · Cited by 118 · see citing works
Junk: Overeating and obesity and the neuroscience of addiction
Fraser, S. (2013) · Addiction Research & Theory · doi:10.3109/16066359.2012.749868 · Cited by 31 · see citing works
Depressive Rage and Criminal Responsibility
Carroll, A., & Forrester, A. (2005) · Psychiatry Psychology and Law · doi:10.1375/pplt.2005.12.1.36 · Cited by 5 · see citing works
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Cited by
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Autonomy, Rationality, and Contemporary Bioethics
Pugh, J. (2020) · doi:10.1093/oso/9780198858584.001.0001 · Cited by 144 · see citing works
Yager, J., Gaudiani, J. L., & Treem, J. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00659-x · Cited by 24 · see citing works
“[28, 29]), take issue with the sweeping assertion that patients with AN lack capacity for medical decision-making.”
BackgroundWade, D. T. (2019) · Clinical Rehabilitation · doi:10.1177/0269215519853013 · Cited by 22 · see citing works
Informed Consent, Autonomy, and Beliefs
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0007 · Cited by 14 · see citing works
Bowpitt, G. (2020) · Housing Care and Support · doi:10.1108/hcs-07-2020-0010 · Cited by 6 · see citing works
Lane, N. M. (2020) · Journal of Medical Ethics · doi:10.1136/medethics-2019-105746 · Cited by 5 · see citing works
“Terminal Anorexia”, Treatment Refusal and Decision-Making Capacity
Jefferson, A. (2024) · Cambridge Quarterly of Healthcare Ethics · doi:10.1017/s0963180124000367 · Cited by 4 · see citing works
Selbstbestimmung und forensische Suchtbehandlung
Querengässer, J., Janele, D., Schlögl, C., & Bezzel, A. (2022) · Der Nervenarzt · doi:10.1007/s00115-021-01254-2 · Cited by 4 · see citing works
Narrative Coherence and Mental Capacity in Anorexia Nervosa
Tate, A. J. M. (2020) · AJOB Neuroscience · doi:10.1080/21507740.2019.1704921 · Cited by 3 · see citing works
Weston, J. (2019) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2019.101524 · Cited by 2 · see citing works
Rational Autonomy and Decision-Making Capacity
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0008 · Cited by 2 · see citing works
Rationality and Decisional Autonomy
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0003 · Cited by 1 · see citing works
Gough, J. (2025) · Philosophy & Public Affairs · doi:10.1111/papa.70010 · Cited by 1 · see citing works
“Craigie and Davies [15] argue that the MCA, read together with the code of practice, is sometimes read broadly enough by clinicians to qualify as an “impaired control” test of the sort used in criminal law and closely related to non-tyranny.”
InfluentialPugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0005 · Cited by 1 · see citing works
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0001 · Cited by 1 · see citing works
Mitigating the risk of assumptions and biases in assessments of mental capacity
Stammers, S., & Bortolotti, L. (2020)
The Prudential Value of Autonomy
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0010
The Practical Dimension of Autonomy
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0006
Rational Decision-Making Capacity in End of Life Decision-Making
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0009
Four Distinctions Concerning Rationality
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0002
Villar, K. D. (2020) · Queensland University of Technology · doi:10.5204/thesis.eprints.206025
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0011
Pugh, J. (2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.003.0004
(2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.002.0004
(2020) · Oxford University Press eBooks · doi:10.1093/oso/9780198858584.002.0005
Shades of grey: choice, control and capacity in alcohol-related brain damage
Kane, N. B., Broderick, N., Rao, E., Keene, A. R., & Rao, R. T. (2023) · BJPsych Bulletin · doi:10.1192/bjb.2023.92
How to prove her wrong: hierarchies of watching in the case of the fasting girl Sarah Jacob
Jacob, M. (2025) · Medical Humanities · doi:10.1136/medhum-2024-012983
“Their common denominator is their source in a fanaticism that is inaudible to law and medicine given their ‘intellectual bias’ (Craigie and Davies 2019) 15 and embrace of an overwhelmingly rational and empirical understanding of the world.”
Race and mental capacity: no panacea
Gough, J. (2025) · The British Journal of Psychiatry · doi:10.1192/bjp.2025.120
Gough, J. (2025) · Psychiatry Psychology and Law · doi:10.1080/13218719.2025.2568960 · Cited by 14 · see citing works
Not fit for purpose: the Mental Capacity Act cannot serve as a safeguard for assisted dying
Gough, J. (2026) · BJPsych Bulletin · doi:10.1192/bjb.2026.10289
- Authors
- Craigie, J., & Davies, A.
- Affiliations
- King's College London (GB)
- Fitness to Practise, Nursing and Midwifery Council, London, UK
- Corresponding author
- Craigie, Jillian
- ORCID
- Craigie, Jillian
- Venue
- Medical Law Review
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-07-23
- Volume
- 27
- Issue
- 2
- Pages
- 215-241
- ISSN
- 0967-0742 (ISSN-L)
- 1464-3790
- PMC
- PMC6536256
- OpenAlex
- W2884141299
- Cited by
- 44
- References
- 6
- Citations by year
- 2026: 15 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 2 · 2020: 19 · 2019: 2
- FWCI
- 6.17
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Medical Law Review (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- PhilPapers (PhilPapers Foundation) (submittedVersion)
- Funders
- Wellcome Trust Research Fellowship (094910/Z/10/Z)
- Nuffield Foundation (AJU/41334)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Sociology and Political Science › Criminal Law and Policy
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
- Keywords
- alcoholism, anorexia nervosa, impaired control, diminished responsibility, cognitive impairment, legal capacity, treatment decision-making, England and Wales
- MeSH terms
- Self-Control, Mental Status and Dementia Tests, Alcoholism, Anorexia Nervosa, Civil Rights, Cognition, Compulsive Behavior, Decision Making, England, Humans, Informed Consent, Social Values, Wales, Bias, Treatment Refusal, Mental Competency, Cognitive Dysfunction
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