Risk-Sensitive Assessment of Decision-Making Capacity: A Comprehensive Defense

Should the assessment of decision-making capacity (DMC) be risk sensitive, that is, should the threshold for DMC vary with risk? The debate over this question is now nearly five decades old. To many, the idea that DMC assessments should be risk sensitive is intuitive and commonsense. To others, the idea is paternalistic or incoherent, or both; they argue that the riskiness of a given decision should increase the epistemic scrutiny in the evaluation of DMC, not increase the threshold for DMC. We respond to the critics' main concerns by providing a comprehensive account of how risk-sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations.

Automated summary

The debate over whether the assessment of decision-making capacity (DMC) should be risk sensitive, meaning the threshold for DMC should vary with risk, has been going on for almost five decades. Some find it intuitive and commonsense that DMC assessments should be risk sensitive. Others argue that this idea is paternalistic or incoherent, and that the riskiness of a decision should increase the scrutiny in evaluating DMC, not the threshold for DMC. In response to these concerns, we provide a comprehensive account of how risk-sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations.