Why we should be sceptical about internalism
Neil Pickering1, Simon Walker1, Giles Newton-Howes2, Bioethics Centre University Of Otago Dunedin2, Wellington 1Bioethics Centre University Of Otago, Dunedin, Otago, New Zealand2Psychological Medicine Wellington School of Medicine, Wellington New Zealand
Abstract
Internalism makes two claims: (1) That to assess someone’s decision-making competence we should attend only to their decision-making processes (and not at all to the outcomes of their decisions). And (2) alignment of decision outcomes with a person’s values is a sign of decision-making competence.
Internalists regularly parade these two claims as if they provided a basis for making competence assessments, and as if they were consistent with one another.
We will seek to make the case that they don’t, and they are not.
They don’t provide a basis for assessment of decision-making competence because claim 1 fails to provide any standards by which competence can be judged and alignment (claim 2) fails to provide an alternative consistent with claim 1.
And they aren’t consistent with one another because the focus on the processes of decision making alone (claim 1) rules out any attention to alignment (claim 2) and alignment (claim 2) rules out the need to look at decision-making processes.
Biography
Neil Pickering has worked in New Zealand at the University of Otago Bioethics Centre for 24 years. His specialist areas of research are in philosophy of psychiatry and mental health, and ethical and conceptual issues related to consent, capacity and competence to consent, and covert treatment.