'Radical Interpretation' and the Assessment of Decision-Making Capacity
'Radical Interpretation' and the Assessment of Decision-Making Capacity
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DOI：
10.1111/japp.12035
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发表时间：
2013-11-01
影响因子：
1.1
通讯作者：
Szmukler, George
中科院分区：
文献类型：
--
作者：
Banner, Natalie F.;Szmukler, George
患者决策能力（DMC）的评估已经成为临床实践的一个重要领域，因为它为考虑非自愿治疗提供了门户，具有重大的伦理意义。英格兰和威尔士《精神能力法》（2005年）规定的DMC测试旨在通过程序化的方式支持自主，减少不必要的家长式作风，重点关注患者如何做出治疗决定。在实践中，要避免考虑信仰和价值观是很困难的，尤其是在有问题或处于边缘的情况下；也就是说，思想的实质内容，而不是简单的认知能力或程序能力。然而，很少有人关注如何在临床环境中评估信仰和价值观，以及什么样的客观性是可能的。我们认为，唐纳德·戴维森的激进解释和慈善原则的关键方面为临床医生如何处理一个人对信仰或价值观的明显干扰是否会破坏他们的DMC这一问题提供了有用的指导。提供了一个案例，并对临床实践的一些影响进行了讨论。
The assessment of patients' decision-making capacity (DMC) has become an important area of clinical practice, and since it provides the gateway for a consideration of non-consensual treatment, has major ethical implications. Tests of DMC such as under the Mental Capacity Act (2005) for England and Wales aim at supporting autonomy and reducing unwarranted paternalism by being procedural', focusing on how the person arrived at a treatment decision. In practice, it is difficult, especially in problematic or borderline cases, to avoid a consideration of beliefs and values; that is, of the substantive content of ideas rather than simple cognitive' or procedural abilities. However, little attention has been paid to how beliefs and values might be assessed in the clinical context and what kind of objectivity' is possible. We argue that key aspects of Donald Davidson's ideas of Radical Interpretation' and the Principle of Charity' provide useful guidance as to how clinicians might approach the question of whether an apparent disturbance in a person's thinking about beliefs or values undermines their DMC. A case example is provided, and a number of implications for clinical practice are discussed.