Capacity evaluation has become a widely used assessment device in clinical practice to determine whether patients have the cognitive ability to render their own medical decisions. Such evaluations, which might be better thought of as “capacity challenges,” are generally thought of as benign tools used to facilitate care. This paper proposes that such challenges should be reconceptualized as significant medical interventions with their own set of risks, side effects, and potentially deleterious consequences. As a result, a cost–benefit analysis (...) should be implemented prior to imposing such capacity challenges, and efforts should be made to minimize such challenges in situations where they are unlikely to alter the course of treatment. (shrink)

Working memory limits are best defined in terms of the complexity of the relations that can be processed in parallel. Complexity is defined as the number of related dimensions or sources of variation. A unary relation has one argument and one source of variation; its argument can be instantiated in only one way at a time. A binary relation has two arguments, two sources of variation, and two instantiations, and so on. Dimensionality is related to the number of chunks, because (...) both attributes on dimensions and chunks are independent units of information of arbitrary size. Studies of working memory limits suggest that there is a soft limit corresponding to the parallel processing of one quaternary relation. More complex concepts are processed by or In segmentation, tasks are broken into components that do not exceed processing capacity and can be processed serially. In conceptual chunking, representations are to reduce their dimensionality and hence their processing load, but at the cost of making some relational information inaccessible. Neural net models of relational representations show that relations with more arguments have a higher computational cost that coincides with experimental findings on higher processing loads in humans. Relational complexity is related to processing load in reasoning and sentence comprehension and can distinguish between the capacities of higher species. The complexity of relations processed by children increases with age. Implications for neural net models and theories of cognition and cognitive development are discussed. (shrink)

Despite their importance in the history of philosophy and in particular in the work of Aristotle and Kant, mental capacities have been neglected in recent philosophical work. By contrast, the notion of a capacity is deeply entrenched in psychology and the brain sciences. Driven by the idea that a cognitive system has the capacity it does in virtue of its internal components and their organization, it is standard to appeal to capacities in cognitive psychology. The main benefit of (...) invoking capacities in an account of the mind is that it allows for an elegant counterfactual analysis of mental states: it allows us to analyze mental states on three distinct yet interrelated levels. A first level of analysis pertains to the function of mental capacities. A second level of analysis pertains to the mental capacities employed, irrespective of the context in which they are employed. A third level of analysis pertains to the mental capacities employed, taking into account the context in which they are employed. This paper develops an account of perceptual capacities. This account involves an analysis of their function, their individuation and possession conditions, the relation between perceptual capacities and their employment, as well as their informational and neural base conditions. (shrink)

The notion of a capacity in the sense of a power to bring about or undergo change plays a key role in Aristotle’s theories about the natural world. However, in Metaphysics Θ Aristotle also extends ‘ capacity ’, and the corresponding concept of ‘activity’, to cases where we want to say that something is in capacity, or in activity, such and such but not, or not directly, in virtue of being capable of initiating or undergoing change. This (...) paper seeks to clarify and confirm a certain view of how Aristotle wishes us to see the relationship between the two uses of ‘ capacity ’ and ‘activity’. To that end, I consider also Aristotle’s employment of the terms in the De Anima, which sheds light on the key examples which direct the discussion in Metaph. Θ. (shrink)

We ordinarily suppose that there is a difference between having and failing to exercise a rational capacity on the one hand, and lacking a rational capacity altogether on the other. This is crucial for our allocations of responsibility. Someone who has but fails to exercise a capacity is responsible for their failure to exercise their capacity, whereas someone who lacks a capacity altogether is not. However, as Gary Watson pointed out in his seminal essay ’Skepticism (...) about Weakness of Will’, the idea of an unexercised capacity is much more difficult to make sense of than it initially appears. The aim of ’Rational Capacities’ is to provide the needed explication of this idea. (shrink)

We ordinarily suppose that there is a difference between having and failing to exercise a rational capacity on the one hand, and lacking a rational capacity altogether on the other. This is crucial for our allocations of responsibility. Someone who has but fails to exercise a capacity is responsible for their failure to exercise their capacity, whereas someone who lacks a capacity altogether is not. However, as Gary Watson pointed out in his seminal essay ’Skepticism (...) about Weakness of Will’, the idea of an unexercised capacity is much more difficult to make sense of than it initially appears. The aim of ’Rational Capacities’ is to provide the needed explication of this idea. (shrink)

The situationist experiments demonstrate that most people's behaviour is influenced by environmental factors much more than we expect, and that ordinary people can be led to behave very immorally. A number of philosophers have investigated whether these experiments demonstrate that subjects' responsibility-relevant capacities are impeded. This paper considers how, in practice, we can assess when agents have a reduced capacity to avoid wrongdoing. It critiques some previously offered strategies including appeals to the reasonable person standard, appeals to counterfactuals and (...) understandability of behaviour, and appeals to base rates of wrongdoing. It then proposes we should think a certain factor impeded capacities when this is the best explanation of a change in patterns of responses. With this approach in hand, I then argue that subjects in many of the situationist experiments are (mostly) excused for their actions. (shrink)

In this commentary on Anneli Jefferson’s Are Mental Disorders Brain Disorders? I endorse her capacitarian approach to responsibility but suggest that the effects of at least some mental/brain disorders on the agent’s psychology show that we cannot neatly separate the epistemic condition from the control condition when assessing agential capacity. I then discuss the labeling issue in the context of rival attributionist accounts of responsibility which hold that agents are responsible if their actions are attributable to them. The incorporation (...) of mental disorders into identity through social processes may open agents with mental or brain disorders open to unfair blame. However, we cannot fully understand the effects of the disorders on agential capacity without closely attending to the social environment that shapes the way the disorder is conceived, enacted, perceived, and responded to over time. (shrink)

"Kant and the Capacity to Judge" will prove to be an important and influential event in Kant studies and in philosophy.

We undertake to bring a phenomenological perspective to bear on a challenge of contemporary law and clinical practice. In a wide variety of contexts, legal and medical professionals are called upon to assess the competence or capacity of an individual to exercise her own judgement in making a decision for herself. We focus on decisions regarding consent to or refusal of medical treatment and contrast a widely recognised clinical instrument, the MacCAT-T, with a more phenomenologically informed approach. While the (...) MacCAT-T focuses attention on individual cognitive performance criteria, an approach oriented by second-person phenomenology brings into view the complex role of time, others and identity in constituting the capacity for individual autonomous judgement. Our phenomenological analysis has consequences both for the practice of capacity assessments and for further research in this arena. Good practice in capacity assessment must attend to decision communities, distributed capacity, and temporal competence, while research on mental capacity will miss the phenomenon if it trains its focus ‘between the ears.’ We illustrate our approach by considering two recent cases of contested capacity: one involving cognitive disability in a dysfunctional decision community, the second presenting the possibility of competent decision-making under conditions of paranoid schizophrenia. (shrink)

It is usually appropriate for adults to make significant decisions, such as about what kinds of medical treatment to undergo, for themselves. But sometimes impairments are suffered - either temporary or permanent - which render an individual unable to make such decisions. The Mental Capacity Act 2005 sets out the conditions under which it is appropriate to regard an individual as lacking the capacity to make a particular decision (and when provisions should be made for a decision on (...) their behalf). -/- To what extent does having capacity require the endorsement of certain values? Drawing on Owens et al (2009), I assess the extent to which understanding relevant information and weighing it in coming to a decision requires certain evaluative commitments. With reference to literature on anorexia nervosa and decisions informed by religious beliefs, I argue that it is difficult to avoid the conclusion that the conditions for capacity are value-laden, and that if this is so it is important to open discussion about which patterns of distorted valuing undermine capacity, and why. (shrink)

Capacity and competence in the field of child and adolescent psychiatry are complex issues, because of the many different influences that are involved in how children and adolescents make treatment decisions within the setting of mental health. This article will examine some of the influences which must be considered, namely: developmental aspects, the paradoxical relationship between the need for autonomy and participation and the capacity of children, family psychiatry, and the duty of care towards children and adolescents. The (...) legal frameworks relevant to consideration of consent and competence will be briefly considered, as well as some studies of children's consent, participation and competence. A case vignette will be used as a focus to consider the complexity of the issue of competence in child and adolescent psychiatry, in the particular mental disorder of anorexia nervosa. (shrink)

In paradigm exercises of agency, individuals guide their activities toward some goal. A central challenge for action theory is to explain how individuals guide. This challenge is an instance of the more general problem of how to accommodate individuals and their actions in the natural world, as explained by natural science. Two dominant traditions–primitivism and the causal theory–fail to address the challenge in a satisfying way. Causal theorists appeal to causation by an intention, through a feedback mechanism, in explaining guidance. (...) Primitivists postulate primitive agential capacities in their explanations. The latter neglect to explain how primitive capacities integrate with findings from natural science. The former do not explain why some feedback mechanism’s activity amounts to the agent’s guidance. In this paper I argue that both traditions should acknowledge a capacity to guide, as actually constituted by the executive system. I argue that appeals to this empirically discovered psychological system explain how individuals guide in a way that integrates with explanations from cognitive science. Individuals’ capacity to guide is embedded in the natural world through the activity of its constituent (mechanistic) components. (shrink)

Introduction: Healthcare practitioners have a legal, ethical and professional obligation to obtain patient consent for all healthcare treatments. There is increasing evidence which suggests dissonance and variation in practice in assessment of decision-making capacity and consent processes. Aims: This study explores healthcare practitioners’ knowledge and practices of assessing decision-making capacity and obtaining patient consent to treatment in the acute generalist setting. Methods: An exploratory descriptive cross-sectional survey design, using an online questionnaire, method was employed with all professional groups (...) invited via email to participate. Data were collected over 3 months from July to September 2015. Survey content and format was reviewed by the liaison psychiatry team and subsequently contained five sections (demographics, general knowledge and practice, delirium context, legal aspects and education/training). Descriptive, univariate and bivariate analysis of quantitative data and qualitative content analysis of qualitative data were undertaken. Ethical considerations: The study was approved by the institutional Human Research and Ethics Committee and informed consent was taken to be provided by participants upon completion and submission of the de-identified survey. Results: In total, 86 participants engaged the survey with n = 24, exiting at the first consent question. Almost two-thirds of respondents indicated that all treatments required patient consent. Knowledge of consent and decision-making capacity as legal constructs was deficient. Decision-making capacity was primarily assessed using professional judgement and perceived predominantly as the responsibility of medical and psychology staff. A range of patient psychological and behavioural symptoms were identified as indicators requiring assessment of decision-making capacity. Despite this, many patients with delirium have their decision-making capacity assessed and documented only sometimes. Uncertain knowledge and inconsistent application of legislative frameworks are evident. Many participants were unsure of the legal mechanisms for obtaining substitute consent in patients with impaired decision-making capacity and refusing treatment. Conclusion: The legal context of decision-making capacity and consent to treatment appears complex for healthcare practitioners. Professional, ethical and legal standards of care in this context can benefit from structured education programmes and supportive governance processes. An understanding of why ‘duty of care’ is being used as a framework within the context of impaired decision-making capacity is warranted, alongside a review of the context of Duty of Care within health policy, guidance and faculty teaching. (shrink)

Are universities able to operate as strategic actors? An organisational sociology based approach supported by a comparative field research project identifies three types of social, cultural and cognitive processes that play a decisive role in building and implementing local capabilities required to mobilise a strategic capacity. The paper identifies how much these processes are present in the four ideal-types of universities defined by crossing their reputation and their metrics-based performance. Such a meso deterministic perspective suggests that universities may position (...) themselves as proactive actors or principals, and not just as agents of national reforms and political demands. Nevertheless, their ability to do it varies according to their type. The paper also explores the implications of such findings for institutional leadership and steering policymakers. (shrink)

We introduce a new framework for understanding how cognitive systems (e.g., humans) learn from experience, based on the concept of representational capacity—the relative amount of representational resources devoted to encoding past experiences. Most paradigms in cognitive science have operated under the assumption that these resources are constrained, forcing cognitive systems to compress rich and noisy experiences to effectively generalize to new situations. We leverage recent advances in computer science to outline the implications of learning with excess capacity, or (...) applying even more representational resources than needed to perfectly memorize all the details of one’s past experiences. In particular, we review evidence suggesting that excess capacity systems can exhibit many of the characteristics of human learning, such as the simultaneous ability to memorize individual experiences and generalize knowledge to new situations. We define and differentiate between constrained (not enough), sufficient (just enough), and excess (more than enough to perfectly capture all the details of one’s past experiences) capacity. We derive empirical properties of learning in each of these capacity regimes, and compare these predictions to effects documented for human learning. We highlight the broad implications of this framework for advancing theoretical and empirical work across cognitive, clinical, and developmental psychology. (shrink)

The question “What is it to be an artifact?” must be distinguished from the question “What is it to be an artifact of kind K?”. Failure to distinguish between these two questions leads to an exaggeration of the role of intentions in the philosophy of artifacts. We accept that intentions are necessary to define the category of artifacts, but we reject the view that intentions are constitutive of what makes something a specific kind of artifact. In the first part of (...) this paper, we discuss a series of cases involving what we call “faith-based artifacts” which often exhibit a social dimension. These cases, we argue, constitute counterexamples to the thesis that something is an artifact of a specific kind if it was produced with the intention that it be an object of that kind. In the second part of the paper, we explain how a capacity-based approach to artifacts, by contrast, can accommodate faith-based artifacts. In the last section, we address an objection to the capacity-based approach. (shrink)

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’s 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. (shrink)

This paper investigates the nature of dispositional properties in the context of artificial intelligence systems. We start by examining the distinctive features of natural dispositions according to criteria introduced by McGeer (2018) for distinguishing between object-centered dispositions (i.e., properties like ‘fragility’) and agent-based abilities, including both ‘habits’ and ‘skills’ (a.k.a. ‘intelligent capacities’, Ryle 1949). We then explore to what extent the distinction applies to artificial dispositions in the context of two very different kinds of artificial systems, one based on rule-based (...) classical logic and the other on reinforcement learning. Here we defend three substantive claims. First, we argue that artificial systems are not equal in the kinds of dispositional properties they instantiate. In particular, we show that logical systems instantiate merely object-centered dispositions whereas reinforcement learning systems allow for the instantiation of agent-based abilities. Second, we explore the similarities and differences between the agent-centered abilities of artificial systems and those of humans, especially as relates to the important distinction made in the human case between habits and skills/intelligent capacities. The upshot is that the agent-centered abilities of truly intelligent artificial systems are distinctive enough to constitute a third type of agent-based ability — blended agent-based ability — raising substantial questions as to how we understand the nature of their agency. Third, we explore one aspect of this problem, focussing on whether systems of this type are properly considered ‘responsible agents’, at least in some contexts and for some purposes. The ramifications of our analysis will turn out to be directly relevant to various ethical concerns of artificial intelligence. (shrink)

IntroductionRights-ethicists intensely debate what properties of an individual are necessary and sufficient in order for that individual to have moral rights. At the heart of this important debate is the issue of whether individuals such as human foetuses, infants, and unconscious adults have moral rights, and if so, what these rights are. This paper focuses on the moral status of unconscious adults, as well as human foetuses, which are potential agents in the sense that they follow a “normal” path of (...) development towards agency. Using Michael Tooley’s (Tooley 1983) and Jeff McMahan’s (McMahan 2002) influential discussions on this topic as a point of departure, this paper defends two claims. (1) Possession of the capacity for autonomous agency that is temporarily “blocked” by sleep or coma is sufficient in order for an individual to have intrinsic worth and thus, moral rights. (2) If possession of the blocked capacity for autonomous agency is sufficient in order for an individual to hav. (shrink)

Mental capacity is a foundational concept in contract law, but the term is metaphorical, and a detailed analysis of three representative judicial opinions shows that the explanations that courts give of the term are equally metaphorical. As such, the term illustrates well the cognitivist view that abstract concepts arise through an imaginative but orderly projection from the domain of bodily and social experience. Legal Realists such as Felix Cohen condemned metaphors for their supposed failure to constrain judges, but recent (...) empirical work suggests that metaphorical thinking is indeed constrained, and accordingly thinkers such as Cohen would probably in fact have welcomed cognitive analysis of law, both for its methods and for its substantively progressive disposition. (shrink)

When a patient lacks decision-making capacity, then according to standard clinical ethics practice in the United States, the health care team should seek guidance from a surrogate decision-maker, either previously selected by the patient or appointed by the courts. If there are no surrogates willing or able to exercise substituted judgment, then the team is to choose interventions that promote a patient’s best interests. We argue that, even when there is input from a surrogate, patient preferences should be an (...) additional source of guidance for decisions about patients who lack decision-making capacity. (shrink)

The dominant interpretation ofMetaphysicsΘ.8 commits Aristotle to the claim that the heavenly bodies’ eternal movements are not the exercises of capacities. Against this, I argue that these movements are the result of necessarily exercised capacities. I clarify what it is for a heavenly body to possess a nature and argue that a body’s nature cannot be a final cause unless the natural body possesses capacities that are exercised for the sake of its naturequaform. This discussion yields a better understanding of (...) what capacities are, what explanatory work capacities do, and what it is to possess a nature. (shrink)

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. (...) Patients who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions. (shrink)

Decision-making Capacity matters to whether a patient’s decision should determine her treatment. But why it matters in this way isn’t clear. The standard story is that dmc matters because autonomy matters. And this is thought to justify dmc as a gatekeeper for autonomy – whereby autonomy concerns arise if but only if a patient has dmc. But appeals to autonomy invoke two distinct concerns: concern for authenticity – concern that a choice is consistent with an individual’s commitments; and concern (...) for sovereignty – concern that an individual exercises control over that which is hers to control. Here, I argue, neither concern can alone explain why dmc matters. Instead, dmc matters because it indicates a harmony between the two concerns – the demands of each concern are more likely to agree if a patient has dmc. This vindicates the standard story, but also makes clear that dmc is an inappropriate gatekeeper for autonomy. (shrink)

Gilbert Ryle's distinction between knowledge-how and knowledge-that faces a significant challenge: accounting for the unity of knowledge. Jason Stanley, an ‘intellectualist’ opponent of Ryle's, brings out this problem by arguing that Ryleans must treat ‘know’ as an ambiguous word and must distinguish knowledge proper from knowledge-how, which is ‘knowledge’ only so-called. I develop the challenge and show that underlying Ryle's distinction is a unified vision of knowledge as ‘a capacity to get things right’, covering both knowledge-how and knowledge-that. I (...) show how Ryle specifies the general notion into knowledge-how and knowledge-that and discuss the mutual interdependence exhibited by the two forms of knowledge. Ryle's positive view of knowledge, properly understood, emerges as an important, neglected, alternative which should be brought back into the ongoing conversation about practical and theoretical knowledge. (shrink)

In "Rational Capacities" Michael Smith outlines the sense of capacity he believes to be required before blame is appropriate. I question whether this sense of capacity is required. In so doing, I consider different ways in which blame might be conditioned.

To systematically compare welfare across species, it is first necessary to explore whether welfare subjects of different species have the same or rather a different capacity for welfare. According to what seems to be the dominant philosophical view, welfare subjects with higher cognitive capacities have a greater capacity for welfare and are generally much better off than those with lower cognitive capacities. Višak carefully explores and rejects this view and argues instead that welfare subjects of different species have (...) the same capacity for welfare despite different cognitive capacities. This book prepares the philosophical ground for comparisons of welfare across species. It will inform and inspire ethicists and animal welfare scientists alike, as well as a broader readership interested in wellbeing, animals, and ethics. (shrink)

Choquet integrals and capacities play a crucial role in modern decision theory. Comonotony is a central concept for these theories because the main property of a Choquet integral is its additivity for comonotone functions. We consider a Choquet integral representation of preferences showing uncertainty aversion (pessimism) and propose axioms on time consistency which yield a candidate for conditional Choquet integrals. An other axiom characterizes the role of comonotony in the use of information. We obtain two conditioning rules for capacities which (...) amount to the well-known Bayes' and Dempster–Schafer's updating rules. We are allowed to interpret both of them as a lack of confidence in information in a dynamic extension of pessimism. (shrink)

Until recently, philosophers debating the rationality of time-biases have supposed that people exhibit a first-person hedonic bias toward the future, but that their non-hedonic and third-person preferences are time-neutral. Recent empirical work, however, suggests that our preferences are more nuanced. First, there is evidence that our third-person preferences exhibit time-neutrality only when the individual with respect to whom we have preferences—the preference target—is a random stranger about whom we know nothing; given access to some information about the preference target, third-person (...) preferences mirror first-person preferences. As a result, the simulation hypothesis has been proposed, according to which third-person preferences will mirror first-person preferences when we can simulate the mental states of the preference target. Second, there is evidence that we prefer negative hedonic events to be in our past (we are first-person negatively hedonically future-biased) only when we view future events as fixed and in no way under our control. By contrast, when we perceive it to be within our power to mitigate the badness of future events, we are first-person negatively hedonically past-biased. This is the mitigation hypothesis. We distinguish two versions of the mitigation hypothesis, the squirrelling version and the heuristic version. We ran a study which tested the simulation hypothesis, and which aimed to determine whether the squirrelling or the heuristic version of the mitigation hypothesis enjoys more empirical support. We found support for the heuristic version of the hypothesis, but no support for the squirrelling version. (shrink)

Clinicians are often called upon to assess the capacity of a patient to appoint a healthcare agent. Although a consensus has emerged that the standard for such assessment should differ from that for capacity to render specific healthcare decisions, exactly what standard should be employed remains unsettled and differs by jurisdiction. The current models in use draw heavily upon analogous methods used in clinical assessment, such as the “four skills” approach. This essay proposes an alternative model that relies (...) upon categorization and sliding scale risk assessment that can be used to determine to how much scrutiny the proxy appointment should be subjected and how much certainty of accuracy should be required in order to maximize the patient’s autonomy and ensure that her underlying wishes are met. (shrink)

This chapter argues that previous accounts of extrapolation, either by reference to capacities or mechanisms, do not adequately address the challenges confronting extrapolation. It then begins the account of how the mechanisms approach can be developed so as to do better. The central concept in this account is what I term comparative process tracing.

BackgroundCommunity engagement is a key component in health research. One of the ways health researchers ensure community engagement is through Community Advisory Boards (CABs). The capacity of CABs to properly perform their role in clinical research has not been well described in many resource limited settings. In this study, we assessed the capacity of CABs for effective community engagement in Uganda.MethodsWe conducted a cross sectional study with mixed methods. We used structured questionnaires and key informant interviews (KII) to (...) collect data from CAB members, trial investigators, and community liaison officers. For quantitative data, we used descriptive statistics while for qualitative data we used content analysis.ResultsSeventy three CAB members were interviewed using structured questionnaires; 58.9% males, median age 49 years (IQR 24–70), 71.2% had attained tertiary education, 42.5% never attended any research ethics training, only 26% had a training in human subject protection, 30.1% had training in health research, 50.7% never attended any training about the role of CABs, and 72.6% had no guidelines for their operation. On the qualitative aspect, 24 KIIs cited CAB members to have some skills and ability to understand and review study documents, offer guidance on community norms and expectations and give valuable feedback to the investigators. However, challenges like limited resources, lack of independence and guidelines, and knowledge gaps about research ethics were cited as hindrances of CABs capacity.ConclusionThough CABs have some capacity to perform their role in the Ugandan setting, their functionality is limited by lack of resources to facilitate their work, lack of independence, lack of guidelines for their operations and limited knowledge regarding issues of research ethics and protection of the rights of trial participants. (shrink)

Democracy is shown to be a non-instrumental good-in-itself (as well as an instrument in securing other goods) by extrapolation from the Aristotelian premise that humans are political animals. Because humans are by nature language-using, as well as sociable and common-end-seeking beings, the capacity to associate in public decisions is constitutive of the human being-kind. Association in decision is necessary (although insufficient) for happiness in the sense of eudaimonia. A benevolent dictator who satisfied all other conditions of justice, harms her (...) subjects by denying them opportunity to associate in the decisions by which their community is governed. (shrink)

Many debates about the moral status of things—for example, debates about the natural rights of human fetuses or nonhuman animals—eventually migrate towards a discussion of the capacities of the things in question—for example, their capacities to feel pain, think, or love. Yet the move towards capacities is often controversial: if a human’s capacities are the basis of its moral status, how could a human having lesser capacities than you and I have the same "serious" moral status as you and I? (...) This book answers this question by arguing that if something is human, it has a set of typical human capacities; that if something has a set of typical human capacities, it has serious moral status; and thus all human beings have the same sort of serious moral status as you and I. Beginning from what our common intuitions tell us about situations involving "temporary incapacitation"—where a human organism has, then loses, then regains a certain capacity—this book argues for substantive conclusions regarding human fetuses and embryos, humans in a permanent vegetative state, humans suffering from brain diseases, and humans born with genetic disorders. Since these conclusions must have some impact on our ongoing moral and political debates about the proper treatment of such humans, this book will be useful to professionals and students in philosophy, bioethics, law, medicine, and public policy. (shrink)

The model for capacity assessment in the United States and much of the Western world relies upon the demonstration of four skills including the ability to communicate a clear, consistent choice. Yet such assessments often occur at only one moment in time, which may result in the patient expressing a choice to the evaluator that is highly inconsistent with the patient’s underlying values and goals, especially if a short-term factor (such as frustration with the hospital staff) distorts the patient’s (...) preferences momentarily. These challenges are particularly concerning in cases, which arise frequently in hospital settings, in which patients demand immediate self-discharge, often during off-hours, while faced with life-threatening risks. This paper examines the distinctive elements that shape such cases and explores their ethical implications, ultimately offering a model for such situations that can be operationalized. (shrink)

This chapter provides an overview of conceptual and ethical issues surrounding mental capacity and supported decision-making in mental healthcare. Mental capacity (also referred to as “competence to consent” or “decision-making capacity”) is the ability of a person to understand the nature and consequences of the available treatment options and to make a treatment decision based on her own values and deeply held preferences. Supported decision-making in the context of healthcare refers to interventions that can enhance the ability (...) of persons to make treatment decisions based on their own values and deeply held preferences. This concept plays a key role in the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). The chapter starts by shedding light on the wider societal significance of the concept of mental capacity by embedding it in discussions around autonomy and paternalism. It subsequently elucidates three approaches to mental capacity: the status approach, the functional approach, and the outcome approach. Then it describes the nature of supported decision-making interventions and legal supported decision-making arrangements. The chapter closes by considering four controversies surrounding mental capacity and supported decision-making, namely those concerning whether the criteria of the functional approach are sufficient for mental capacity, whether mental capacity is risk-relative, whether supported decision-making can fully replace substitute decision-making, and whether the concept of mental capacity is inherently discriminatory. (shrink)

In this paper I criticize Cartwright's analysis of capacities and offer an alternative analysis. I argue that Cartwright's attempt to connect capacities to her condition CC fails because individuals can exercise capacities only in certain contexts. My own analysis emphasizes three features of capacities: 1) Capacities belong to individuals; 2) Capacities are typically not metaphysically fundamental properties of individuals, but can be explained by referring to structural properties of individuals; and 3) Laws are best understood as ascriptions of capacities.

The vulnerability turn has contributed to the concept of vulnerability becoming an established part of the legal lexicon. By adopting a legal-philosophical perspective, this paper will explore what might be considered the most interesting theoretical outcome of the vulnerability paradigm: the concept of universal legal capacity, enshrined in Article 12 of the Convention on the Rights of Persons with Disabilities. The reasoning will focus on two main areas. First, the theoretical background of this reflection will be clarified, by investigating (...) the main arguments of the current debate on vulnerability. Such a reflection will provide the necessary background to explore the relationship between autonomy and vulnerability. The second part of this paper specifically aims to analyse the content and legal implications of Article 12 CRPD. The exegesis of Article 12 will attempt to show that said Article is theoretically founded on the paradigm of vulnerability. Following that, a ‘reality test’ will give the opportunity to discuss some of the main positions that are present in the existing literature on the topic, with particular attention to the relationship between support and substitution. The expression vulnerable capacity has been used in order to emphasise the complex analysis required to adequately address the issue of capacity from a theoretical perspective. It will be argued that legal capacity can be considered vulnerable because it characterises a (universally) vulnerable subject. (shrink)

The purpose of this article is threefold: (a) to describe the relevant ethical and legal issues associated with decisional capacity among minors and to discuss the importance of these concepts for children and adolescents living with HIV, (b) to provide a framework for assessing the decisional capacity of children and adolescents with HIV, and (c) to present a model for thinking about how to use this assessment data to guide action along the protection-autonomy continuum.

The electric activities of cortical pyramidal neurons are supported by structurally stable, morphologically complex axo-dendritic trees. Anatomical differences between axons and dendrites in regard to their length or caliber reflect the underlying functional specializations, for input or output of neural information, respectively. For a proper assessment of the computational capacity of pyramidal neurons, we have analyzed an extensive dataset of three-dimensional digital reconstructions from the NeuroMorphoOrg database, and quantified basic dendritic or axonal morphometric measures in different regions and layers (...) of the mouse, rat or human cerebral cortex. Physical estimates of the total number and type of ions involved in neuronal electric spiking based on the obtained morphometric data, combined with energetics of neurotransmitter release and signaling fueled by glucose consumed by the active brain, support highly efficient cerebral computation performed at the thermodynamically allowed Landauer limit for implementation of irreversible logical operations. Individual proton tunneling events in voltage-sensing S4 protein alpha-helices of Na+, K+ or Ca2+ ion channels are ideally suited to serve as single Landauer elementary logical operations that are then amplified by selective ionic currents traversing the open channel pores. This miniaturization of computational gating allows the execution of over 1.2 zetta logical operations per second in the human cerebral cortex without combusting the brain by the released heat. (shrink)

Transgender and gender expansive (TGE) youth often seek a variety of gender-affirming healthcare services, including pubertal suppression and hormone therapy requiring that TGE youth and their parents participate in informed consent and decision making. While youth must demonstrate the ability to understand and appreciate treatment options, risks, benefits, and alternatives as well as make and express a treatment choice, standardized approaches to assess the capacity of TGE youth to consent or assent in clinical practice are not routinely used. This (...) scoping review identified the currently available data regarding adolescent capacity to consent to gender-affirming medical treatments. Articles relevant to assessing adolescent capacity for clinical decision-making were identified using OVID Medline, Web of Science, and PubMed. Articles were reviewed and thematically analyzed. Eight relevant articles were identified using three tools for measuring adolescent clinical decision-making capacity: Measure of Understanding, Measure of Competence, and MacArthur Competence Assessment Tool (MacCAT). These studies explored hypothetical treatment decisions, mental health treatment decisions, HIV treatment decisions, genetic testing decisions, and gender-affirming medical decisions. Only one study specifically examines the capacity of TGE youth to consent to medical treatments. Age was correlated with capacity in most, but not all studies. Other studies found cognitive measures (IQ, literacy, numeracy) may impact important aspects of capacity (understanding and reasoning). For clinicians caring for TGE youth, tools such as the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) may prove useful, in conjunction with consideration of youth developmental abilities and utilization of shared decision-making practices. A standardized, collaborative approach to assessing TGE youth capacity would benefit TGE youth and their parents, and allow clinicians to more easily resolve ethical concerns. (shrink)

It is a common assumption that medical institutions may permissibly use the force of law to seek remuneration for costs incurred in medical intervention done without patient consent. In this paper, we challenge that assumption. Specifically, we claim that: Generally, when patients who lack capacity are given medical treatment without their consent, those practitioners who treated them are wrong to use legal mechanisms to secure remuneration for that treatment.

I motivate and defend a new account of ignorance for which ignorance is the lack of a suitable explanatory connection between (i) one’s exercise of epistemic abilities and (ii) believing the truth. This view carves out a previously unexplored option space in the ongoing conceptual debate about ignorance in analytic epistemology and is shown to yield better results than competing views of ignorance, including those that define ignorance as a lack of knowledge, a lack of true belief, or as characterized (...) by a failure of inquiry. Unlike these other views, the account defended here places an agent’s exercise of her epistemic abilities at its core, enabling it to provide a more nuanced explanation for various instances of ignorance and non ignorance, as well as for the evaluative character of ignorance. (shrink)