Standing, H and Lawlor, R orcid.org/0000-0002-9621-2977 (2019) Ulysses Contracts in Psychiatric Care: Helping Patients to Protect Themselves from Spiralling. Journal of Medical Ethics, 45 (11). pp. 693-699. ISSN 0306-6800
Abstract
This paper presents four arguments in favour of respecting Ulysses Contracts in the case of individuals who suffer with severe chronic episodic mental illnesses, and who have experienced spiralling and relapse before. First, competence comes in degrees. As such, even if a person meets the usual standard for competence at the point when they wish to refuse treatment (time 2), they may still be less competent than they were when they signed the Ulysses Contract (time 1). As such, even if competent at time 1 and time 2, there can still be a disparity between the levels of competence at each time. Second, Ulysses Contracts are important to protect people’s most meaningful concerns. Third, on the approach defended, the restrictions to people’s liberty would be temporary, and would be consistent with soft paternalism, rather than hard paternalism: the contracts would be designed in such a way that individuals would be free to change their minds, and to change or cancel their Ulysses Contracts later. Finally, even if one rejects the equivalence thesis (the claim that allowing harm is as bad as doing harm), this is still consistent with the claim that, in particular cases, it can be as wrong to allow a harm as to do a harm. Nevertheless, controversies remain. This paper also highlights several safeguards to minimise risks. Ultimately, we argue that people who are vulnerable to spiralling deserve a way to protect their autonomy as far as possible, using Ulysses Contracts when necessary.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © Author(s) (or their employer(s)) 2019. This is an author produced version of a paper published in the Journal of Medical Ethics. Uploaded in accordance with the publisher's self-archiving policy. |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Arts, Humanities and Cultures (Leeds) > Inter-Disciplinary Ethics Applied (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 12 Aug 2019 09:30 |
Last Modified: | 19 Nov 2019 15:53 |
Status: | Published |
Publisher: | BMJ Publishing Group |
Identification Number: | 10.1136/medethics-2019-105511 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:149563 |