made by an individual who has the capacity to make the decision and who understands the details and consequences of said decision ( Beauchamp and Childress , 2001 , p . 58 ). When it comes to making treatment decisions , patients with anorexia may meet some of the aforementioned criteria for autonomy . For example , patients may understand the details and consequences of their treatment decisions ( Martens , 2015 , p . 184 ). However , as I will subsequently demonstrate , many anorexic patients do not possess the capacity to make autonomous treatment decisions .
It is important to emphasise that to be ascribed autonomy relevant to making treatment decisions , a patient need only possess specific capacity . Here , ‘ specific capacity ’ refers to a patient ’ s ability to make rational decisions regarding their eating behaviours , ‘ exercise levels , nutrition , physical health and treatment ’ ( Matusek and O ’ Dougherty , 2010 , p . 444 ). This is contrasted with ‘ global capacity ’ which refers to overall capacity and is not a requirement when it comes to ascribing patients the autonomy to make treatment decisions ( Matusek and O ’ Dougherty , 2010 , p . 443 ).
3.3 . The Traditional Account of Capacity
Determining capacity in patients with anorexia is ‘ by no means a straightforward task ’ ( Tan et al ., 2006 , p . 4 ). This is partly due to the complex presentation of anorexia but can be mainly attributed to the inadequacy of the traditional account and means of assessing capacity in anorexic patients ( Martens , 2015 , p . 187 ).
According to the traditional account , capacity consists of the following abilities : understanding , reasoning , appreciation , and expressing a choice ( Grisso et al ., 1995 , p . 129 ). The ‘ understanding ’ criterion dictates that an individual must be able to comprehend the ‘ factual information relevant to the decision they are being asked to make ’ ( Culver and Gert , 2004 , p . 260 ). In the context of treatment refusal in anorexia , this encompasses the ability to understand the nature of anorexia and the risks and benefits of proposed treatment strategies . ‘ Rationality ’ is a reasoning criterion which demands that an individual must be capable of engaging in reasoning processes such as ‘ weighing and comparing alternatives ’ ( Martens , 2015 , p . 184 ). ‘ Appreciation ’ refers to the ability to apply information to oneself and one ’ s circumstances ( Grisso et al ., 1995 , p . 129 ). Finally , ‘ expressing a choice ’ simply refers to the ability to communicate one ’ s decision in some way ( Grisso et al ., 1995 , p . 129 ). According to the traditional account , if a patient with anorexia possesses these abilities , they have the capacity to make treatment decisions .
One prominent issue with the traditional account of capacity is that it focuses predominantly on cognitive or intellectual abilities . This is problematic because the treatment refusal of anorexic patients cannot be fully explained in terms of cognitive or intellectual deficits ( Martens , 2015 , p . 187 ). To elaborate , evidence shows that patients with anorexia generally demonstrate a strong understanding of the facts of their disorder , its consequences , and proposed treatments ( Tan et al ., 2003a , p . 701 ). According to the traditional account , the aforementioned patients possess the capacity to refuse treatment . However , at the same time , these patients often arrive at ‘ prima facie unreasonable ’ and potentially fatal treatment decisions ( Martens , 2015 , p . 186 ). This suggests that the traditional account of capacity ‘ fails to capture ’ the difficulties that anorexic patients experience when making decisions
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