The Effect of Mental Illness on Autonomous Decision-Making Capacity.
One key tenet of medical ethics is respect for patient autonomy. Respect for autonomy generally requires treating patients as authors of their own life plans, shared decision-makers in treatment planning, and ultimate authorities in treatment choices.
However, mental illness can impair patient ability to coherently form life-plans, or can induce decision-making contrary to personal goals or values defined during periods of better mental health. Such impairment can set in tension two senses of autonomy: autonomy as a negative liberty right, freedom from external coercion; and autonomy as true internal sovereignty over personal agency.
Mental health treatment should seek to support the fullest possible degree of true patient autonomy, with the least degree of coerciveness, in the long run. In the shorter run, however, it can be ethically ambiguous to discern what respecting patient autonomy means, if the nature of the mental health duress impairs or renders inconsistent rational decision-making capacity. In extreme cases, health professionals can seek court approval to treat mental health patients against their stated will, either to advance important benefits for the patient, or to honor what they consider the patient’s longer-term autonomy, or both. Most states have legal processes to consider short-term non-voluntary hospitalization for emergency evaluation, non-voluntary inpatient treatment, and non-voluntary outpatient treatment.
While the law treats decision-making capacity dichotomously—either a patient is deemed to have it or not, by documented standards—health care professionals must ethically respond to a wide spectrum of fuller or lesser capacity; to patients whose capacity fluctuates over time; and to patients capable of making some kinds of decisions but not others, given the particular nature of their mental health challenge.