Mental Capacity in Relationship

Camillia Kong is Lecturer in Philosophy at the University of Kent and Research Associate at the Ethox Centre, University of Oxford. She researches and has published on moral and political philosophical issues around the medico-juridical concept of capacity, mental disorder, and intellectual impairment. Her recent work also examines ethical issues around psychiatric genomics.

What should medical and legal professionals do when a person with intellectual impairment chooses to remain within an abusive and disabling environment? Should these professionals even be considering the difference between relationships and care environments which promote or disable the autonomy of individuals with a learning disability or mental disorder? Or is this paternalism gone one step too far?

In my new book Mental Capacity in Relationship: Decision-making, dialogue, and autonomy I explore these complex issues through the prism of mental capacity legislation in England and Wales and human rights conventions. Legal developments have revealed a number internal and external criticisms around the concept of mental capacity: in England and Wales medico-juridical professionals protect the right of autonomy of those who pass a legal functional test of mental capacity, but how this test should be interpreted is subject to internal debate.

Some legal judgments suggest an intrapersonal focus of mental capacity, whilst others indicate that the promotion of autonomy amongst those with impairments should have an interpersonal focus, where mental capacity will depend on the relationships and communities around the individual in question. Moreover, with the advent of the UN Convention for the Rights of Persons with Disabilities (CRPD), external critiques charge that the concept of mental capacity represents outdated, paternalistic, and discriminatory attitudes towards those with impairments, fundamentally designed to undermine their right of autonomy.

Both these internal and external critiques are addressed in my defense of a relational concept of mental capacity, where relationships and intersubjective dialogue have an important impact on the decisional capacity of individuals with impairments. In the book, I recommend caution against disposing with the concept of mental capacity as endorsed by the ‘will and preferences’ interpretation of Article 12 in the CRPD and further argue that mental capacity cannot be reducible to abilities ‘within one’s own head’, despite this pre-eminent understanding in both theory and practice. Core philosophical ideas that are operationalised within mental capacity law – such as rights, rationality, autonomy, and beneficence – need not presume an individualistic focus, but can be interpreted relationally.

The Unencapsulated Nature of Episodic Memory

Johannes Mahr (pictured above) is a PhD student in the Department of Cognitive Science at Central European University in Budapest. His work centers on the question of how the capacity for complex forms of communication has shaped higher cognition in humans. During his PhD he developed a novel account of the nature and function of episodic memory, which focuses on its role in communication. You can read about it here.

We usually think that when we remember the past, we form beliefs based on whatever we remember. When you remember that you went to the supermarket and bought a bottle of champagne yesterday, you take yourself to believe that this is indeed what you did because you remember it. Similar to perception, it seems to us that remembering provides us with evidence on the basis of which we form our beliefs. In the case of perception it has been widely argued that the processes by which we perceive our environment are encapsulated from what we already believe. That is, just because you might believe that there is a bottle of champagne behind your computer screen, you will not suddenly perceive one when you walk around your desk. Rather, perceptual input will inform your higher-level beliefs so as to cause you to revise your mistaken belief about the location of the champagne.

PERFECT 2017 Memory Workshop

On May 5th, Project PERFECT hosted our workshop at the University of Cambridge. In a previous post on the workshop, the individual talks were summarised, so the current post focuses on some of the common themes that emerged in the talks and discussion: (a) the active nature of episodic memory and its potential to generate knowledge; (b) the implications of the existence of observer memories; (c) the role of others in the generation of knowledge through episodic memory.

It seems obvious that we have knowledge of past episodes in our lives, but Kourken Michaelian and Dorothea Debus highlighted how humans are active in the process of forming our memories. This might seem to show that we cannot have knowledge through episodic memory because episodic memory systems do not passively represent the past. Michaelian discussed this point through the lens of work on the reconstructive nature of memory. In the cognitive sciences, it is now widely accepted that episodic memories are constructed from traces of information stored in memory. The process of construction involves activity from the person doing the remembering.

Debus focused on how people have to exert efforts to ensure that they remember a particular event, thinking, for example, What was it that I did last Sunday? Both Michaelian and Debus aimed to reconcile the activity involved in episodic memory with this memory producing knowledge. Michaelian argued that the reconstruction involved in remembering produces representations that are true to events as they occurred (even if they do not exactly replicate the experiences that people had of the events), so can produce accurate memories, and knowledge, of those events. Debus argued that as long as an active intervention does not interfere with the believer meeting epistemic norms, those that lead to accurate beliefs, the intervention does not prevent the formation of the memory leading to knowledge.

Relatedly, I argued that evidence of the activity involved in the formation of memory is not only consistent with memory systems producing knowledge, it provides reason for thinking that memory systems bring significant epistemic benefits. I discussed the idea that people actively construct memories and showed that this feature of human memory systems increases the chance of true beliefs belief formed about things other than past experiences.

The Argumentative Theory of Reasoning

This post is by Hugo Mercier, Cognitive Scientist (French National Center for Scientific Research) and co-author (with Dan Sperber) of The Enigma of Reason. In this post, he discusses the argumentative theory and refers to some of his most recent publications (1; 2; 3). 

It is easy nowadays to find long lists of biases (such as this one). In turn, these lists of biases have given rise to numerous attempts at debiasing. The popular system 1 / system 2 framework has been useful in framing these attempts at debiasing. System 1 would be a set of cognitive mechanisms that deliver quick, effortless intuitions, which tend to be correct but are prone to systematic mistakes. System 2 would be able to correct these intuitions through individual reflection. Teaching critical thinking, for instance, can then be thought of as a way of strengthening system 2 against system 1.

The problem is that, as Vasco Correia noted in a recent post, debiasing attempts, including the teaching of critical thinking, have not been quite as successful as we might like. He suggests that instead of trying to change individual cognition, we should manipulate the environment to make the best of the abilities we have.

Essentially, this is the point that Maarten Boudry, Fabio Paglieri, Emmanuel Trouche, and myself have made in a recent article. We ground our analysis in the argumentative theory of reasoning. According to this theory, reasoning is not a system 2 like homunculus that would be able to oversee other cognitive mechanisms. Instead, it is just another intuitive mechanism among many others. Its specificity is to bear on reasons: reasoning evaluates and finds reasons. By contrast, the vast majority of our inferences go one without any reasons being processed.