Discussion Mental capacity act: 'unwise decisions' versus duty of care.

[Forever Sleep]

I've always been intrigued with this part of The Mental Health act:

'Principle 3: Unwise decisions
People have the right not to be treated as lacking capacity merely because they make a decision that others deem 'unwise'. Everyone has their own values, beliefs and preferences which may not be the same as those of other people.' (Mental capacity act 2005.)

I've always wondered whether CTB falls within this remit of what might be considered 'bad decision making' by others. In which case- having ideation alone SHOULDN'T mean a person lacks mental capacity (and therefore- should still be entitled to the right to autonomy.) I'm guessing they draw the line at suicide though... Maybe even self harm...

I guess I'm most curious about how the notion and legal requirement: 'duty of care' plays into this. I suppose we shouldn't actually be shocked when organizations/ professionals try to stop us from CTB- they likely need to be seen to be doing so. I guess the REALLY tricky part is for them to know when they can step back and say- it's up to you. I wonder in the current climate whether they can ever actually do that. What do you think?

 

[Pluto]

Lawyers can have a field day with phrasing like that. It's a bit like the concept of moral relativism; as soon as we acknowledge the possibility that other people may have differing yet equally legitimate worldviews, all fundamental ideas about morals, and perhaps even definitions of mental illness are at risk of collapsing.

The legal system is pro-life at its core, though the Hippocratic Oath for physicians includes the following statements, in sequence:

• THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
• I WILL RESPECT the autonomy and dignity of my patient;

This alone opens the door to endless debate around bodily autonomy in the case of suicidal ideation. Suicide can be interpreted as a basic right of human autonomy, or a problematic manifestation of an individual's dysfunctional circumstances/psychology.

On a larger scale, suicide can be viewed as a means to reduce needless suffering, for example amongst palliative care patients. But it is also viewed as a public health issue. Just as public policy around, say, standards of new car safety or drivers' licensing statistically affects real-world road fatalities, standards in parenting, education, media, public services and mental health can be said to impact suicide-related fatalities. The difference is that nobody would consciously choose a fatal automobile accident... unless suicidal.

The complicating factor is that people in deeply distressing situations may legitimately 'choose' to die, yet the circumstances leading up to that point - trauma, health crises, poverty, social isolation - represent the direct opposite of what they would have 'chosen'. Hence, it could be seen as a desperate choice made precisely because of a lack of empowerment to make other choices in life.

What it always comes down to is a need to view the situation with an appropriate level of nuance and complexity. The entire debate exists along a very morbid spectrum, with nonchalant death on one extreme, and immense long-term suffering on the other.