Relational Autonomy and the Promotion of Decisional Capacity in Individuals with Impairments

Please note: If you are not a member of the Ethox Team and are planning on coming, please can you email me to let me know.

With recent legal developments in England and Wales and human rights conventions, there has been increased debate about concept of mental capacity to determine whether individuals with impairments can make decisions about their care and treatment. My book defends a concept of mental capacity, but challenges the individualistic focus it currently has in medico-juridical practice and theoretical literature. The book defends a relational concept of mental capacity and suggests that assessments of capacity must consider how relationships can enable or disable the decision-making abilities of individuals with impairments. By exploring key concepts, such as rights, autonomy, and rationality, which underlie mental capacity, the book suggests that there needs to be an ethical reorientation of mental capacity, towards the examination of the how primary relationships as well as capacity assessments themselves must display key competencies in order to ensure that autonomy skills are promoted and encouraged, as well as to better situate, interpret, and understand the choices and actions of individuals with impairments.

My presentation will present the argument in one of the chapters, where I reconceive the account of autonomy that is operationalised within the concept of mental capacity. Legal appeals to autonomy in mental capacity law are characterised by imprecision, where the experiences of individuals with impairments are neglected. The argument pushes against the philosophical tendency to treat individuals with impairments as ‘contrast’ cases, as well as challenges the strong individualism within contemporary accounts of autonomy. Instead, the chapter seeks to establish a ‘shared’ conception of autonomy and proposes a relational account that revolves around two conditions: perceptual and autonomy competencies. The phenomenology of absorbed coping draws attention to how impairment can affect one’s perceptual engagement with the world, whilst a relational account of autonomy competencies take into consideration the socially-acquired nature of one’s self-understanding and self-reflection. This chapter further provides interpersonal and intrapersonal indicators of autonomy-enabling relationships.