Authentic decision-making capacity in hard medical cases

Because autonomy is regarded as central to modern bioethics; there is a considerable focus on the criteria by which autonomy may be judged. The most significant criterion used in day-to-day practice is decision-making capacity. A person who is decision-making capacitous is regarded as autonomous ipso facto. This rarely considered background analysis places a great deal of weight on the notion of decision-making capacity and how this is assessed. A person who is deemed to lack autonomy will be treated differently to a person who is deemed to have autonomy, at least when it comes to some medical decisions. In this paper we consider how extending the standard approach to decision-making capacity may deliver a more authentic reflection of autonomy. We refer to this as the ‘authentic approach’, to highlight its difference. The ethical advantages of extending the standard approach authentically in hard medical cases is analysed using a case, with recommendations about application described.