Unreasonable reasons: Normative judgements in the assessment of mental capacity
Open accessAbstract
The recent Mental Capacity Act (2005) sets out a test for assessing a person's capacity to make treatment choices. In some cases, particularly in psychiatry, it is unclear how the criteria ought to be interpreted and applied by clinicians. In this paper, I argue that this uncertainty arises because the concept of capacity employed in the Act, and the diagnostic tools developed to assist its assessment, overlook the inherent normativity of judgements made about whether a person is using or weighing information in the decision-making process. Patients may fail on this criterion to the extent that they do not appear to be handling the information given in an appropriate way, on account of a mental impairment disrupting the way the decision process ought to proceed. Using case law and clinical examples, I describe some of the normative dimensions along which judgements of incapacity can be made, namely epistemic, evaluative and affective dimensions. Such judgements are complex and the normative standards by which a clinician may determine capacity cannot be reduced to a set of criteria. Rather, in recognizing this normativity, clinicians may better understand how clinical judgements are structured and what kinds of assumption may inform their assessment.
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The choice of an appropriate cut-off point is left to researchers and is a potential source of reporting bias.
“So it is ultimately left to researchers to decide on an appropriate cut-off point and this is a potential source of reporting bias (Banner, 2012).”
From Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis (2024) · cites this paper as Banner, 2012
In “Empirical approaches to capacity” (page unavailable), the paper says diagnostic tools are calibrated using expert clinicians’ judgements, but it does not say researchers choose cut-off points. A search for cut-off thresholds and reporting bias found no passage addressing either claim. (LLM, conf=0.76)
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- Authors
- Banner, N. F.
- Affiliations
- King's College London (GB)
- Corresponding author
- Banner, Natalie F.
- ORCID
- Banner, Natalie F.
- Venue
- Journal of Evaluation in Clinical Practice
- Publisher
- Wiley
- Published
- 2012-09-21
- Volume
- 18
- Issue
- 5
- Pages
- 1038-1044
- ISSN
- 1356-1294 (ISSN-L)
- 1365-2753
- PMC
- PMC3472025
- OpenAlex
- W1513011425
- Cited by
- 91
- References
- 41
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 5 · 2023: 2 · 2022: 4 · 2021: 35 · 2020: 5 · 2019: 5 · 2018: 3 · 2017: 2 · 2016: 9 · 2015: 4 · 2014: 4 · 2013: 9 · 2012: 1
- FWCI
- 6.52
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Evaluation in Clinical Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Funders
- Wellcome Trust (086071)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Keywords
- Mental Capacity Act 2005, mental capacity assessment, treatment decision-making, epistemic normativity, clinical judgment, mental impairment
- MeSH terms
- Cognition Disorders, Humans, Judgment, Patient Participation, Physician-Patient Relations, Mental Competency, Empirical Research
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