Understanding is a fundamental concept in medical ethics. I want to discuss two contrasting senses in which medical treatments require understanding on behalf of the patient. The first of these is very familiar, and much discussed. The second is less so.
The first and most familiar sense in which medical treatment requires a patient’s understanding is that understanding is crucial in determining their capacity to consent. The UK Mental Capacity Act of 2005 states that ‘a person lacks capacity… if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.’ In turn, ‘a person is unable to make a decision for himself if he is unable (a) to understand the information relevant to the decision, (b) to retain that information, (c) to use or weigh that information as part of the process of making the decision, or (d) to communicate his decision (whether by talking, using sign language or any other means).’ As condition (a) makes clear, understanding is legally required in order for a patient to make a decision for themselves regarding their treatment. No understanding, no capacity to decide; no capacity to decide, no possibility of consent.
Psychiatric illnesses present a number of interesting (and troubling) issues here. By their very nature, mental disorders can impair a subject’s capacity to understand their condition or a proposed treatment, thus rendering them incapable of consenting to such treatments. Serious ethical questions arise in evaluating whether, or in what circumstances, it is permissible to administer treatments to such individuals, despite their inability to consent.
The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.