Law and Philosophy

, Volume 34, Issue 4, pp 433–467 | Cite as

The Space Between Second-Personal Respect and Rational Care in Theory and Mental Health Law

  • Camillia Kong


In recent human rights and legal instruments, individuals with impairments are increasingly recognised as agents who are worthy of respect for their inherent dignity and capacity to make autonomous decisions regarding treatment and care provisions. These legal developments could be understood using Stephen Darwall’s normative framework of the second person standpoint. However, this paper draws upon phenomena – both in legal developments and recent court cases – to illustrate theoretical difficulties with the contractualist underpinnings of Darwall’s account if applied to questions of what is owed to individuals with disabilities. I argue that, under Darwall’s framework, whether the threshold for second-personal competence has been met will determine whether respect or rational care is owed to them. This fact distorts our understanding of what we owe to persons with mental impairments—in part because it limits respect to relations that are symmetrical and reciprocal. In light of these challenges the paper offers an account of hermeneutic competency, which can be applied to non-reciprocal and asymmetrical relationships. This alternative account will be of practical import to judicial determinations of best interests under the Mental Capacity Act 2005 in England and Wales. It will also be of broader theoretical interest to any legal system that deals with people with mental disabilities.


Second-person standpoint Respect Care Darwall Contractualism Dignity Mental health law Best interests Hermeneutics Anorexia nervosa 


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My thanks to the British Academy for their generous funding during the course of writing this paper under their Postdoctoral Fellowship Scheme. I am grateful to Stephen Darwall, Raymond Tallis, Genevra Richardson, Michael Dunn, and an anonymous reviewer for their constructive comments on earlier drafts of this paper. Special thanks to Rob Kar, whose detailed critical engagement greatly improved the paper.

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.The Ethox Centre, Nuffield Department of Population HealthUniversity of OxfordOxfordUK

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