Accounting for Intuition in Decision-Making Capacity: Rethinking the Reasoning Standard?

Abstract

Given the ethical implications of assessments of decision-making capacity, adequate definitions and appropriate assessment criteria are essential, especially with regard to clinical practice in psychiatry. Currently applied standards have been criticized for emphasizing exclusively cognitive abilities. In particular, the present paper questions the adequacy of the current <i>reasoning</i> criterion. Referring to dual-process models of decision making, it is argued that the <i>reasoning</i> standard embraces only one side of the duality that is rational deliberation, and fails to take proper account of intuitive decision making. An outline of intuition’s potency in health care decisions informs the present account of why the current <i>reasoning</i> standard fails to take adequate account of patients’ decision-making preferences and of major deficits in intuitive reasoning. Toward a more comprehensive understanding, a possible reconceptualization of reasoning as the ability to decision-related self-reflection is advanced, and implications for evaluation, challenges, and limitations are discussed.