Capacity: An issue of life & death

Realistic concept of decisionmaking. Compass needle pointing the blue word decision over a paper background

In western medicine, we have a concept called ‘Mental Capacity’. We will call it ‘capacity’ for short. If a person has ‘capacity’ then that means they have the ability to make an informed decision, about a proposed procedure/action.

So for example, let us say a man comes in to hospital with severe abdominal pain and the doctor diagnoses an infected appendix. The man is offered different options to treat it. These options include a surgical operation and also no treatment. The doctor discusses the benefits and risks of each of these options. If the man has ‘capacity’ then he can either refuse or accept to go ahead with the operation. In other words, he has the ability to make an informed decision.

Now here is the interesting part. As long as the man has ‘capacity’, he can in all his right decline the procedure, potentially resulting in his death. Legally, the doctor would not be able to operate on this man, if that was his choice and he had ‘capacity’.

Now of course, there are some very strict conditions that must be applied to make sure that a person has ‘capacity’ but essentially, these are:

  • Understanding the information he is receiving, including the consequences of saying no
  • Remembering the information long enough, so that he can come to a decision
  • Making the decision without pressure from anybody else
  • Communicating the decision (by any means: e.g. writing, speaking etc.)

If all 4 of these conditions are met, then the person has ‘capacity’ and as a result, their decision must be respected. And yes, that means even if it may result in his death.

Now let us extrapolate this fundamental cornerstone of Western medicine and see what significance it may have in our personal lives.

Let us approach a subject that is just as important as health decisions. Let us call it ‘life view’ or perhaps even more accurately, ‘belief systems’.

We are very lucky as human beings to be able to make decisions about our own belief systems, in most parts of the world.

For example, if I live in Britain, I can choose to adopt any belief I like, within the legal framework of the country of course. (The reason I mention this is because if I choose that my belief ideology is to paint slogans on peoples’ cars, then clearly I am damaging property and breaking the law).

Assuming you choose a belief system, we can usually narrow most of the world’s belief systems into a few key majority groups. These are most likely going to be;

  1. belief in God
  2. belief in multiple Gods,  
  3. belief in no God,
  4. don’t know

Those are probably the 4 key choices, when you narrow them down.

Now there are belief systems that lie in between these 4 cohorts, but for now, we will stick to the majority, statistically.

Of course, you can break these down further, but we are trying to keep things simple, for arguments sake. For example, you could say belief in God, entails Christianity, Islam, Judaism and Sikhism. You could also say belief in multiple gods entails Hinduism, Buddhism and Pantheism. And then you could say that belief in no god fits in with Darwinism or Atheism. And perhaps those who are unsure fit in with agnosticism.

Now, let us circle back to the start of our essay. Let us say for a moment, that each human being on earth, has the free will to make their own choices about the belief system which they choose to adopt. That seems reasonable, after all it is the basis of a free world, to be able to choose one’s own belief system.

Now let us apply the principle of ‘capacity’ to this decision making process and see where it takes us.

Suppose I approach a man randomly in Italy. I ask him, what is your belief system. On the likelihood of probabilities he may say Christianity. Now suppose i then applied the principles of capacity, to his decision making process. I would use the 4 point criteria mentioned earlier:

  • Understanding the information he is receiving, including the consequences of saying no
  • Remembering the information long enough, so that he can come to a decision
  • Making the decision without pressure from anybody else
  • Communicating the decision (by any means: e.g. writing, speaking etc.)

Now let us break down each of these steps, one by one, as applied to the man’s ‘belief system’.

Let us address the first point. The key to making such a ‘life decision’ would first rest on receiving and understanding the information about ‘life views’. To make this fair, he should receive the information on all the major options, i.e. (No God, One God, multiple Gods, unsure; again you can delve into each major option within these 4 categories, to be thorough). This would allow him to make an informed decision, as he is made aware of all the major options available to him. The second step would be to make sure that he understands those options and what they entail. The second step is also important, as he needs to be presented with an unbiased view of each option.

For example, if the option of God is presented to him from a radical atheist, then you may possibly get a biased view. The way around this is to have the philosophy of the doctor who presents information to a patient in that it must be unbiased and factually correct. There are a few ways to achieve this with ‘life views’: the first step, is to get the information from a reliable source. This could be first pass sources, for example the Bible, Quran, Torah, Darwin etc. The likeness of this is like reading all the literature on infected appendixes and their treatment options and then coming to your own decision. The information could also be from a very knowledgeable person on the topic, e.g. an Imam, Priest, Rabbi or Scholar of Atheism. The likeness of this is if you wanted to find out about heart surgery, you would not approach a spinal surgeon, rather you would go the expert in the field (i.e. the heart surgeon), to get the most accurate information. Now the last part of the first criteria of capacity is a little more tricky, it reads ‘including the consequences of saying no’;

  • Understand the information he is receiving, including the consequences of saying no

Here you would also want to know what the consequences of saying no to each option are, for each ‘life view’. For simplicity, from an atheist perspective, there would be no long term consequences. You die at the end of your life and nothing more happens thereafter, apart from the loss of all cherished memories and feelings. However, in most God believing life views, the consequences may be hell, purgatory or heaven etc.

Now let us move onto the second point in ‘capacity’.

  • Remembering the information long enough to make a decision.

This point has medical origins, as if you have a patient who has dementia, then they may forget the information you gave them 5 minutes ago and therefore they cannot make an informed decision. In a decision like ‘life choices’ this is less applicable, as you would assume most people would remember the information they have been given, in order to come to their decision.

The third point in capacity is a very important one:

  • Making the decision without pressure from anybody else

In a decision like ‘life views’, too often there is pressure from society, family and friends to conform to the societal norm. This kind of pressure can vary depending on where you are in the world, the culture of the people and the intensity of their beliefs. The extreme form of this is when you are physically made to change your beliefs, potentially at risk of life or injury. This is simply unacceptable as it goes against the tenants of capacity. Therefore, the decision a person makes with regards to ‘life views’ must be without pressure. Yes, you can go out and get information from friends and family. Yes, you can explore others’ opinions on the topic. But the eventual decision, whatever that may be, must be without pressure from anyone else. It is the basis of free choice and free will.

Finally, we come to the last point in ‘capacity’:

  • Communicate the decision (by any means: e.g. writing, speaking etc.)

Now in the medical world, you should communicate the decision you have made. A surgeon would be super perplexed if at the end of his discussion with you, you decided to remain silent forever on the issue. Yes, maybe you may need more time to think, but you would usually express that and then come to your decision, if any. With regards to ‘life view’ this point however is somewhat obsolete, as you do not need to express your decision to anyone, if you wish. You can keep this as a personal choice for the rest of your life. However, there is the option if you wanted that you could inform family or friends and the wider community.

Now let us return to our Christian man in Italy. He may first state that he does not know about some of the other options, or perhaps he does not know about them well enough, to make an informed decision. Or perhaps he has never had a truthful narrative on them, because the only source of information on the options has been the media. Therefore, does this man have ‘capacity’ with regards to his life choice. The answer would be, probably not. Which brings us to the question, if this man does not fulfil the criteria for capacity to come to the decision he has made about his life view, then how valid is his decision?

The important thing to stress here, is not that there is anything wrong with the final choice you make about your ‘life view’, this is the freedom of choice for each human, but the steps in which you came to this choice.

So I leave you with this thought. Have you come to an informed decision about your life view? If you have, well done, you have made a well informed decision. If on the other hand, you have not, then is it possible that your life beliefs may be changed, once you understand all the remaining options and their consequences? Perhaps?

Finally, to make things clear within this essay, no reference is being made to which ‘life belief’ is right or wrong. Only the steps in which that ‘life belief’ has come about. Just like the surgeon who wishes to have the best interests of his patient at heart, by explaining to him the options that he is entitled to and the consequences they entail, perhaps the same can apply to ‘life decisions’ and the belief systems we hold.

If you have found this essay useful, please share with a friend, using the links below.

Click + Share Now!