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Rational Autonomy and Decision-Making Capacity

Rationalist accounts of autonomy are often criticized on the basis of anti-paternalist concerns: If only rational decisions can be autonomous, one might worry that eccentric decisions may not be respected, and that more people would be found to lack decision-making capacity. The main aim of this chapter is to show how a rationalist approach can respond to the various ways in which such anti-paternalist concerns can be raised. The author first outlines some prominent accounts of decision-making capacity in the law and clinical literature, and claims that the widely adopted sliding-scale view of capacity need not fall foul of anti-paternalistic concerns. He then defends a rationalist approach to understanding decision-making capacity in ideal contexts from anti-paternalist concerns. The author concludes by responding to an epistemic version of the anti-paternalist objection in non-ideal contexts, according to which incorporating considerations of rationality into assessments of decision-making capacity would make costly errors in this assessment more likely.