Ditching decision-making capacity

Daniel Fogal, Ben Schwan

Research output: Contribution to journalArticlepeer-review


Decision-making capacity (DMC) plays an important role in clinical practice - determining, on the basis of a patient's decisional abilities, whether they are entitled to make their own medical decisions or whether a surrogate must be secured to participate in decisions on their behalf. As a result, it is critical that we get things right - that our conceptual framework be well-suited to the task of helping practitioners systematically sort through the relevant ethical considerations in a way that reliably and transparently delivers correct verdicts about who should and should not have the authority to make their own medical decisions. Unfortunately, however, the standard approach to DMC does not get things right. It is of virtually no help in identifying and clarifying the relevant ethical considerations. And, embedded in the prevailing anti-paternalist paradigm, DMC assessments obfuscate and distort the underlying ethical justification for granting or withholding decisional authority. Here, we describe the core commitments of the standard approach to DMC and then highlight three problems with it. We then argue that these problems are significant enough that they call for more than merely tinkering and fine-tuning; variations of the standard approach cannot adequately address them. Instead, we should ditch DMC.

Original languageEnglish (US)
Article numberjme-2023-109047
JournalJournal of Medical Ethics
StateAccepted/In press - 2023


  • Decision Making
  • Ethics- Medical
  • Mental Competency
  • Paternalism
  • Personal Autonomy

ASJC Scopus subject areas

  • Health(social science)
  • Issues, ethics and legal aspects
  • Arts and Humanities (miscellaneous)
  • Health Policy


Dive into the research topics of 'Ditching decision-making capacity'. Together they form a unique fingerprint.

Cite this