Re-Engineering Decisional Capacity

Abstract: What, if anything, should be done with the standard four-abilities model of decisional capacity? Conservatives hold that we should leave the standard model alone; the objections raised against it can be answered by clarifying rather than changing it. Revisionists, however, advocate tweaking the standard model, adding some further ability/condition to the list. Finally, nihilists contend that the concept of decisional capacity can’t do what we need it to do, and that we should stop using it. I propose a framework for understanding the choice between these views. Familiar disagreements among proponents of these views can productively be settled through conceptual engineering, I argue: the project of evaluating concepts according to how well they help us meet our needs—and altering concepts insofar as they don’t. Such a project requires determining which needs animate our use of the concept of decisional capacity, assessing whether the concept serves our needs, and revising/rejecting the concept if necessary. Ultimately, I build a case for revisionism over conservatism or nihilism. The concept of decisional capacity should help us meet two needs in the clinical setting, I claim: (1) our need to be protected from violations of our bodily integrity and autonomy and our need to be protected from self-harm that is involuntary, unwanted, or not endorsable upon reflection. In light of these needs, I contend that conservatism and nihilist approaches face insuperable difficulties, and I end by evaluating various revisionist proposals, such as welfarist views and authenticity/autonomy views.

Keywords: decisional capacity, conceptual engineering, bodily integrity