Mental capacity and autonomy are often understood to be normatively neutral – the only values or other norms they may presuppose are those the assessed person does or would accept. We show how mental disorder threatens normatively neutral accounts of autonomy. These accounts produce false positives, particularly in case of disorders (such as depression, anorexia nervosa, and schizophrenia) that affect evaluative abilities.
Two normatively neutral strategies for handling autonomy-undermining disorder are explored and rejected: a blanket exclusion of mental disorder and functional tests requiring consistency, expression of identity, reflective non-alienation, or lack of compulsion. Finally, we suggest ways in which substantivist alternatives to neutrality can be made more promising through increased transparency, democratic contestability of conditions for capacity and autonomy, and a historically sensitive caution concerning restrictions of liberty.
Pre-publication draft. Published version available from Cambridge University Press.Download paper on Hidden Substance: Mental Disorder as a Challenge to Normatively Neutral Accounts of Autonomy as a PDF
How to cite this document:
(2013) Hidden Substance: Mental Disorder as a Challenge to Normatively Neutral Accounts of Autonomy. International Journal of Law in Context, 9(1): 53-70. DOI 10.1017/S1744552312000481