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    LoyalLoyalJusticeJustice
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    Home/Original/inverse
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    Inverse View

    It is not the case that For practical purposes, a ruling on decisional capacity must be all-or-nothing (bivalent), not a matter of degree.

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    Reasons For

    2 perspectives
    Reason for 1 of 2
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    • 1.Decisional capacity is constituted by multiple discrete cognitive functions (understanding, reasoning, appreciation, expression) that can each vary independently.
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    • 2.A bivalent ruling that collapses this multidimensional profile into yes/no destroys clinically actionable information needed to tailor supported decision-making interventions.
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    • 3.The UN Convention on the Rights of Persons with Disabilities (Art. 12) legally mandates supported decision-making that presupposes graduated, domain-specific capacity rather than binary substituted judgment.
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    Reason for 2 of 2
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    • 1.The argument from administrative convenience (P4) is a pragmatic consideration, not a conceptual truth about the nature of capacity itself.
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    • 2.Legal systems already accommodate graded authority structures—partial guardianship, conservatorship limited to specific domains, and advance directives—demonstrating that bivalence is a contingent institutional choice, not a logical necessity.
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    • 3.Faden and Beauchamp's autonomy framework distinguishes degrees of substantial autonomy, showing that honoring self-determination does not require treating it as an on/off property.
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    Reasons Against

    1 perspective
    Reason against
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    • 1.Decision-making authority cannot be partial — either a patient has final authority over a decision or someone else does.
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    • 2.If a patient has decisional capacity to make decision X, others must honor her choice even if they disagree.
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    • 3.If a patient lacks decisional capacity to make decision X, a guardian or surrogate must decide for her.
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