Dr Anson Fehross1
1University Of New South Wales; University Of Sydney; Macquarie University, , Australia
Biography:
Anson Fehross is a bioethicist and philosopher with a focus on autonomy, substitute decision-making, axiology, and metaphysics within the bioethical context.
He earned his PhD from Sydney Health Ethics (USYD) in 2022. His thesis advances an argument in favour of rethinking proxy decision-making, advancing a novel model where proxies are selected based on shared values rather than knowledge of the patient's wishes.
Currently, Anson is a sessional academic at the University of New South Wales, Macquarie University, and the University of Sydney. He looks forward to completing the set by working for UTS some day.
Abstract:
When assessing competence, the temptation is to evaluate a patient against objective criteria as the patient is at a particular time. Yet, as many know, our capacities may fluctuate. For example, someone with bipolar disorder might meet the NSW Capacity Toolkit's standards but still act against long-term wishes—draining their bank account by gambling, or engaging in risky thrill-seeking behaviour. This is because diachronic unity isn’t required for decisional capacity; we are given the latitude to act in ways that disregard our prior commitments. The capacity threshold is low, and is set low on purpose.
However, we often expect more of ourselves than what the law, or clinical guidelines, expect. We may believe that we should act according to our longstanding beliefs and recognise that certain conditions can fall below our baseline capacities. A practical solution might be advance directives, detailing what capacity means for us in terms of not just what decisions we make, but our reasoning habits, our goals, and so on. Yet this requires considerable ability to communicate these aspects of ourselves clearly to future strangers.
Instead, I propose using 'narrative archetypes' to explain what capacity looks like for us. Rather than weaving a complex narrative about how we make decisions, we can draw from examples in literature, film, and television. While these comparisons are approximations and often idealisations—reflecting how we want to decide rather than how we actually do—they are valuable in helping to clarify what we believe our baseline capacity to be.