BMJ  2006;332:119 (14 January), doi:10.1136/bmj.332.7533.119-a

Letter

Mental health legislation and decision making capacity

Capacity is of more than practical benefit

The first 150 words of the full text of this article appear below.

Editor—Doyal and Sheather's suggestion to base mental health legislation on capacity is bold and timely, but Chiswick's commentary misses the point.¹ Freedom to choose assumes the ability to make choices, or autonomy and decision making capacity are synonymous. The principle of autonomy is enshrined as the highest possible biomedical principle, trumping all others.²

Common law allows enforced treatment only because in certain situations patients are considered to have lost decision making ability, and therefore autonomy, by virtue of their physical illness. For reasons that are never explained, this important ethical principle is not extended to people with mental illness. To add to the moral confusion, most mental health professionals justify the detention of patients with mental illness by using similar arguments to that used in common law,³ while opposing the incorporation of these principles into formal mental health legislation.

Doctors are locked into a diagnostic paradigm that the concept of . . . [Full text of this article]

John Hampden Unit, Stoke Mandeville Hospital, Aylesbury HP21 8AL brian.murray@bmh.nhs.uk

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