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Should Neuroscience Inform Judgements of Decision-Making Capacity?

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Abstract

In this article, I present an argument that suggests neuroscience should inform judgments of decision-making capacity. First, I review key behavioral and neurocognitive data to demonstrate that neuroscientific tests might be predictive of decision-making capacity, and that these tests might inform clinical judgments of capacity. Second, I argue that, consistent with the principles of autonomy and justice, such data should inform judgements of decision-making capacity. While the neuroscience of decision-making capacity still requires time to mature, there is strong reason to believe that neuroscience might assist clinicians in adjudicating difficult cases in the future. This article focuses on the assessment of capacity in brain injury patients who have profound communication impairments, however, the overarching aim of the article is to highlight the potential use of neuroscience to improve our understanding of the relationship between cognition and decision-making capacity.

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Notes

  1. This approach has been criticized in the literature. Critics argue that it leads to a risk asymmetry, wherein a decision to accept a clinician’s recommendation could be deemed less risky (and thus requires less capacity) than a decision to refuse therapy [28, 29]. Nevertheless, the notion that medical decisions have varying stakes continues to be a feature of the received framework of decision-making capacity [30]. For the purposes of this article, I accept this framework.

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Acknowledgements

This article emerged from a unique collaboration between the Rotman Institute of Philosophy and the Brain and Mind Institute at the University of Western Ontario. I thank Charles Weijer, Louis Charland, Tim Bayne, Andrea Lazosky, Mackenzie Graham, Molly Cairncross, Chris DiTeresi, and two anonymous reviewers for helpful comments and discussion. This research was supported by the Vanier CGS program and the Canadian Institutes of Health Research.

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  1. Institute for Philosophy and Public Policy, George Mason University, 4400 University Drive 3F1, Fairfax, VA, 22030, USA

    Andrew Peterson

  2. Department of Philosophy, George Mason University, Fairfax, VA, USA

    Andrew Peterson

  3. Rotman Institute of Philosophy, University of Western Ontario, London, Canada

    Andrew Peterson

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Peterson, A. Should Neuroscience Inform Judgements of Decision-Making Capacity?. Neuroethics 12, 133–151 (2019). https://doi.org/10.1007/s12152-018-9369-4

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