Deciding for Oneself: Autonomous Judgement in History, Theory, and Practice (The Essex Autonomy Project)

Lead Research Organisation: University of Essex
Department Name: School of Philosophy and Art History

Abstract

Individual autonomy is a prized value in modern life. The capacity for self-governance is commonly seen as a crucial component of moral and psychological maturity, while the cultivation and preservation of the conditions for individual self-determination has been a central ambition of broadly liberal political arrangements. Recent legal developments have reinforced this long-standing tradition while also applying it in novel ways. The right to autonomy (often under the heading 'the right to privacy') has come to occupy a central place in European human rights law and in landmark decisions of the US Supreme Court, while in the UK legislation such as the Mental Capacity Act of 2005 has made key legal and medical decisions turn on the question of whether a patient has 'mental capacity' - the capacity to make a decision for him- or herself. A guiding thread in all this is a conception of what we shall call autonomous judgement: the capacity for self-determination in making decisions.
But while these ideas have become familiar at the level of moral and political rhetoric, both in theory and in practice they present fundamental difficulties. What does it mean to be autonomous in the making of decisions? To what extent must an autonomous decision be a rational one? How can or should a clinical or legal practitioner, care-giver or social worker determine whether a particular judgement (as, for instance, about the discontinuation of medical care or the disposition of property) has been undertaken autonomously? Such determinations can have dramatic real-world consequences-in determining whether a patient should be force-fed, for instance, or whether an executor should implement a will. But the proper basis for such determinations is far from clear. Indeed, in what sense can an act of judgement be a matter of self-determination at all, given that one of the ideals of good judgement is that a judge's decision should be determined by the best evidence?
Deciding for Oneself is a three-year interdisciplinary research initiative based in the Philosophy Department at the University of Essex. Our fundamental aim is to clarify the nature and value of judgemental autonomy, both for its own sake, and in order to provide orientation for those who must apply this notion-whether as parents, medical practitioners, legal professionals, or simply as citizens.
Our approach to these issues is in equal measures theoretical, practical, and historical. A crucial element of our methodology is to bring together philosophers working on the theory of autonomy and judgement with working professionals in the law, psychiatric medicine, and social policy. Philosophical theories can be tested and strengthened by application to real-world challenges, while practitioners can make use of philosophical approaches to find a way through some of the vexing challenges endemic to these issues. Our historical approach in turn holds out promise for illuminating both the theoretical and practical issues. A number of contemporary challenges regarding judgemental autonomy are best diagnosed and addressed with reference to the contested history that produced them. One important element in this will be to engage the critics who have objected to the very ideal of autonomous judgement.
Research will be conducted in large part through a series of interdisciplinary workshops, public lectures and international conferences, many of which will be open to the public. Among the research outputs for the project will be a website, 'Green Paper' technical reports, and a curriculum for a Knowledge Transfer 'Master Class' for the dissemination of results. In addition there will be a series of more conventional academic outputs, including a monograph, research articles and collections of essays. Above all, our aim is to cultivate an interdisciplinary network of researchers and practitioners will advance expertise on the challenges intrinsic to the ideal of judgemental autonomy.

Publications

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Freyenhagen F (2013) Hidden substance: mental disorder as a challenge to normatively neutral accounts of autonomy in International Journal of Law in Context

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Freyenhagen F (2017) Autonomy's Substance Autonomy's Substance in Journal of Applied Philosophy

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Martin W (2018) Fichte's Creuzer review and the transformation of the free will problem in European Journal of Philosophy

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Martin W (2012) An unblinkered view of best interests. in BMJ (Clinical research ed.)

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Martin W (2011) Mental capacity and the applied phenomenology of judgement in Phenomenology and the Cognitive Sciences

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Martin W (2017) Obstacles in the Assessment of Intuitive Decision-Making Capacity in Philosophy, Psychiatry, & Psychology

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Martin, W (2017) Human Rights and Human Experience in Eating Disorders in Journal of Psychosocial Studies

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Martin, WM Brain Injury, Mental Capacity and Unwise Decisions in Elder Law Journal

 
Description Distributed Capacity and Decision-Communities: Making a decision FOR oneself is not something that one does BY oneself. Decision-making capacity (DMC) therefore cannot be assessed without taking into account the relationships in which the decision-maker stands to others in her decision-making community. DMC can never be reduced to neurophysiological categories, and psychological metrics such as the MacCAT(T) run the risk of focusing attention too narrowly on individual cognitive performance.

The Interests of One and the Interests of Others: The law mandates that decisions made on behalf of a person lacking decision-making capacity must be made in the best interests of the patient. But assessing the best interests of one person often requires that the interests of others be taken into account. It is therefore not correct to insist that the best-interest decision-maker should disregard the interests of others.

Hidden Ethical Substance: The aspiration to liberal neutrality meets an intrinsic limit in the assessment of decision-making capacity in persons suffering from psychiatric disorders. Normatively neutral accounts of autonomy, when applied to the challenges of assessing decision-making capacity in persons with schizophrenia or anorexia nervosa, systematically yield "false positives." The substantial ethical commitments at work in the assessment of DMC should not be hidden, but should be brought out into the open for public discussion and democratic debate.

Temporal Abilities and Decision-Making Capacity: The statutory abilities comprising decision-making capacity are underlain by a set of temporal abilities that vary in the population of persons diagnosed with depression. Loss of temporal abilities (particularly the ability of an individual to project herself into a variety of self-implicating and normatively variable futures) puts decision-making capacity at risk.

Antinomies of Autonomy: The current state of mental health law in England and Wales exhibits a set of systematic antinomies. This should not be seen as a flaw of the legislation; the antinomies in law reflect an underlying antinomial structure at work where the vocations of care are practiced and regulated in a broadly liberal legal environment.
Exploitation Route The distinction between functional and dysfunctional decision communities needs to be refined and lessons drawn for applying this distinction both in legal and medical contexts, and in distinguishing between due and undue influence.

The research findings of this project with regard to (a) the assessment of decision-making capacity and (b) the assessment of best-interests, can inform practice and public policy in law, medicine and social care. Our own training activities, public policy engagement, and collaboration with public bodies (including mental health charities) constitute important steps in this direction. Further work in improved training and a revised Cope of Practice to the Mental Capacity Act are natural next steps.
Sectors Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice

URL http://autonomy.essex.ac.uk/
 
Description 1. The Essex Autonomy Project has produced a growing body of interdisciplinary research on the legal/psychiatric concept of "mental capacity." That research is now directly impacting the conduct of so-called "capacity assessments" by medical professionals and social workers acting under the Mental Capacity Act of 2005, and is advancing the understanding of mental capacity among policy makers and government officials. Both in the UK and in many other jurisdictions, the law distinguishes between those possessed of "mental capacity" and those who are lacking in such capacity. Adults who have the capacity to make a particular decision for themselves (e.g., a decision about whether to accept or refuse medical treatment) generally have a right to do so. But those who lack capacity for a particular decision generally lose that right. This raises theoretical, ethical and practical problems about the meaning of "mental capacity," about what is involved in "making a decision for oneself," and about how to assess the ability of individuals to do so. By examining capacity assessments from a philosophical and phenomenological perspective new insights have been drawn from the practical process of assessment and the implications this has for patient consent or refusal of medical treatment. Professor Martin and Dr Freyenhagen have trained psychiatrists in their findings and have undertaken consultative roles with the Maudsley teaching hospital, leading to the development of a richer understanding of the factors involved in capacity assessments. 2. This research has led to improvements in the training of health and social care practitioners in the area of best interest decision-making. The research project worked closely with practitioners in the field of clinical and psychiatric medicine, health and social care, the law and the police through a series of workshops and on-site consultancy and produced a series of training modules to help practitioners think through the philosophical and ethical dilemmas of their work. The number of practitioners attending workshops increased as the project developed and there is evidence that results from the project being adopted by practitioners involved with the implementation of public policy and the legal standards associated with the Mental Capacity Act (2005). EAP research has clarified and explored questions that arise in the implementation of the UK's Mental Capacity Act. Their research in this area has resulted in a series of engagements with policy makers, mental health advocacy groups, senior members of the judiciary, and social-care, healthcare, and legal practitioners. Through these engagements the EAP has guided and informed policy debate and discussion of how best to implement the legal standard of best interests. The EAP has also deverloped a body of online resources for policy makers and practitioners concerned with the legal concept of best interests decisions. The EAP website hosts Green Paper Reports, Briefings, and Research Articles, each of which present EAP research in a form accessible and relevant to the concerns of practitioners. Feedback from practitioners has been extremely positive, and practitioners have particularly commented on the value of linking practice with current philosophical research and legal case studies allowing them to reflect on the ethical and philosophical implications of their decisions. Many of the practitioners who have attended EAP workshops are in a managerial or training position in their organisation and we have received feedback that the ideas propagated by EAP research is filtering into training and developement at a local level. For example: "[The] EAP has been really helpful to me in training. I have revised the training materials to reflect the learning from the workshops and summer school. I train adult 'safeguarding leads' in the application of the MCA. I have revised the materials to raise questions of procedural/ substantive autonomy, particularly in relation to vulnerability. This has helped leads to identify when the safeguarding procedures do and don't need to be triggered. I've had feedback that this helped one social worker deal with a very contentious decision regarding whether or not a woman with HIV should undergo an caesarean. The social worker advocated a decision in line with the woman's expressed values and wishes against the medical team. The social worker reported how the work on value and best interests assisted her. I put this down to a change I made in my training following the EAP workshops." John Leighton, Social Care Institute of Excellence.
First Year Of Impact 2011
Sector Communities and Social Services/Policy,Education,Healthcare,Government, Democracy and Justice
Impact Types Policy & public services

 
Description Assisted Decision Making Bill, Northern Ireland
Geographic Reach National 
Policy Influence Type Participation in a national consultation
Impact In July 2013 the Irish Parliament published the Assisted Decision-Making (Capacity) Bill. This legislation was introduced after a period of intense scrutiny of mental health legislation, with the Irish Parliament attempting to bring their national legislation in line with the UN Convention on the Rights of Persons with Disabilities. Wayne Martin was invited by Amnesty International Ireland to facilitate a seminar attended by fifteen organisations, including government agencies, professional bodies and public sector lobbying groups, who had been working together to develop recommendations for Irish legislators drafting the new bill. This seminar was followed in November 2012 by a workshop facilitated by EAP, in which Amnesty International Ireland's 'citizens' jury' were asked to explain their process and decisions to NGOs and professionals engaged in the development of new mental health legislation in Ireland. Martin's contribution to Amnesty's campaign on Ireland's new legislation was well received by their Public Affairs Executive: The Essex Autonomy project was of significant help to our mental health campaign. Wayne Martin's expertise and enthusiasm shone through, and this married with the unique philosophical approach was of great helpBoth workshops were successful in challenging people to be more creative in their thinking about autonomy and were catalysts for stimulating and challenging discussions. Public Affairs Executive, Amnesty International Ireland
 
Description Autonomy Practitioner Training
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact Since 2010 this practitioner network has allowed the EAP to build a training programme for professionals in psychiatry, social work, and health care on issues pertaining to mental capacity. The training programme communicates the main research findings to trainees for practical application. This programme includes the Autonomy Summer School, an annual three-day training course that equips frontline practitioners with an understanding of the philosophical ideal of autonomy and provides a forum for the discussion of the dilemmas surrounding its implementation. The Summer School has been running since 2011. Feedback shows that trainees were influenced by what they learnt from the Summer School, and that as a result their practice has been informed by EAP research. Over 90% of delegates in 2012 rated the Summer School 'very useful'; using a scale of 1 to 6, delegates' levels of understanding before and after the training raised by an average of 2.2 in 2013; and feedback comments have included 'your expertise is highly valuable to frontline practice', 'some new material presented here that I can integrate into practice' and 'very useful to think about for my practice'. Since 2011 EAP has also offered a series on-site workforce training modules for health and social care practitioners. These modules were developed from the Autonomy Summer School syllabus and address the issues faced by practitioners who conduct capacity assessments. Feedback from these events provides evidence that the training has changed practice. The majority of participants stated in exit surveys that their knowledge on capacity assessments has increased through the training; 82% of participants from Herefordshire County Council indicated that the training had been 'very useful'. Testimonials from research users also show that trainers in the relevant professional fields have revised their training materials to incorporate the insights of Essex research on mental capacity. We include one example of this testimonial evidence below: "The Essex Autonomy Project has been really helpful to me in training... I train adult 'safeguarding leads' in the application of the MCA. I have revised the materials to raise questions of procedural/ substantive autonomy, particularly in relation to vulnerability...The green papers are of consistently high quality and have been useful resources to help practitioners understand the concepts behind the MCA. We have referred practitioners to the 'inherent jurisdiction' green paper to inform decisions about whether or not a case is suitable for Court." Mental Capacity Act training manager at Cambridgeshire County Council and MCA development manager at the Social Care Institute of Excellence
 
Description Best Interests Assessors training day - Hertfordshire Council
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Best Interests training session - Herfordshire University
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description British Association of Brain Injury Case Managers Training
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Buckinghamshire Supervisory Board: DoLS Safeguards Update Training
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Engagement with House of Lords Select Committee inquiry 2013
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
 
Description Maudsley Masterclass in Mental Capacity
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Suffolk County Council Staff Development Day
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description Training on Best Interests Decision Making
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
Impact EAP research has resulted in a series of engagements with policy makers, mental health advocacy groups, senior members of the judiciary, social-care and health-care professionals, and civil servants. Through these engagements the EAP has guided and informed policy debate and discussion of how best to implement the legal standard of best interests, and in some cases whether best interests decision-making is acceptable at all. Since 2010 members of the Essex team have worked directly with the Office of the Public Guardian, the Law Commission, the Court of Appeal, the Department of Health, the Ministry of Justice, the Official Solicitor, the Court of Protection, the British Medical Association, the Royal College of Medicine, the Royal College of Psychiatry, Amnesty International Ireland, and the Mental Health Foundation. EAP's engagement with these institutions has included organising and contributing to practitioner events (Community Care Conference, November 2012; working seminar at the Royal College of Psychiatrists, April 2013; public debate with a KCL Professor of Law and Judge Gordon Ashton of the Court of Protection, March 2013) and two public policy roundtables. The roundtables were organised by the EAP and co-sponsored by the Office of the Public Guardian. These were closed door meetings, held under the Chatham House Rule, in which discussion of best interest decision making was guided by briefing documents drafted by members of the EAP research team and based on EAP research. Participants of these meetings found it useful to discuss the current Best Interests climate with other professionals, guided by EAP research. One participant gave this feedback: Their small-scale public policy seminars have fostered frank and free exchange of ideas across the usual professional divides, and have helped explore and communicate important recent developments in the law that governs social care. The 'Green Paper Technical Reports' and 'Seminar Digests' available on their website provide valuable and accessible analysis of key developments and dispute. For example, their document 'Deprivation of Liberty and DoLS' provides a useful analysis of early reactions to the Court of Appeals ruling in Cheshire West and Chester Council v P [2011] EWCA Civ 1257. I recently made reference to this digest in my keynote address to a large audience of local authority officials and social workers at Leeds. Former Chair of the Law Commission and current Member of the Court of Appeal
 
Description West Midlands Best Interests Assessors Annual Update training for Shropshire Council 2017
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description West Midlands Best Interests Assessors Update training for Shropshire Council
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
 
Description 'Today' Programme broadcast 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Wayne Martin was invited to participate in a discussion on the Today Programme when it was revealed that the Court of Protection is to decide whether a mentally unstable pregnant woman should be forcibly sterilised to prevent her becoming pregnant again. Professor Martin and Mencap's David Congdon debate whether the court should have this power.



http://autonomy.essex.ac.uk/eap-research-on-bbc-radio

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Year(s) Of Engagement Activity 2011
URL http://autonomy.essex.ac.uk/eap-research-on-bbc-radio
 
Description Autonomous Judgement: Challenges and Strategies 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact This first workshop for the project brought together researchers in philosophy, law and psychiatry to discuss the challenges of autonomous judgement. The workshop consisted of one presented paper by Dr Joel Anderson of Utrecht University on 'Philosophical Models of Autonomy: An Overview' to start the programme, followed by technical briefing papers on aspects of autonomous judgement and the MCA and MHA, plus capacity assessments in clinical settings and in the social welfare sector. The workshop concluded with a discussion of case studies drawn from recent legal cases and relevant research.

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Year(s) Of Engagement Activity 2010
 
Description Between Moral Failure and Psychopathology? Autonomy and Resposibility in Social Welfare 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Social welfare policies are driven by two apparently conflicting objectives: to satisfy unmet welfare need and to promote personal responsibility. Reconciling both is a key challenge for the welfare state, particularly at a time of cuts to public serves

The principle of welfare conditionality is increasingly seen as the solution to this dilemma, insofar as it limits entitlement to certain welfare goods, such as social housing and unemployment allowances, to 'deserving' applicants. Those whose needs have arisen as a result of imprudent or irresponsible choices are thereby disqualified from assistance. The extent to which the state should assume responsibility for such people is a live political issue:

"If you are vulnerable and in need, we will look after you. And if you hit hard times, we'll give unprecedented support. But in return, we expect you to do your bit." (David Cameron, 17 February 2011))

However, this approach is beset by problems. Firstly, it affects innocent third-parties (particularly children) who suffer the consequences of unmet need through no fault of their own. Secondly, policymakers face the challenge of distinguishing, in a transparent and defensible manner, between those who are blameless/deserving/entitled and those who are not. Thirdly, by holding people to account for allegedly irresponsible behaviour in the past, it risks leaving them less able to assume responsibility in the future. Finally, it neglects the grey area on the continuum of autonomy-capacity, between capacitous moral failure and psychopathological incapacity, within which people satisfy legal tests of mental capacity but nevertheless are less than able to make choices that promote their wellbeing.


This workshop assessed the theoretical adequacy and practical applicability of a 'normative capacities' approach to the public policy challenges in this arena.

This workshop led to an increase in requests for training from social care practitioners.
Year(s) Of Engagement Activity 2012
 
Description Capacity Assessments: Ethical, Political and Metaphysical Issues 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Mental capacity has become a central concept in social care and mental health services; yet disagreement persists over what capacity requires, how and when it is best assessed, and to what extent a person's mental incapacity can legitimise taking decisions on their behalf. This workshop aimed to bring together psychiatrists, lawyers, social workers, philosophers, carers and representatives of advocacy groups to discuss mental capacity in law, practice and theory. We focused on three clusters of issues:



- When should mental capacity be questioned? Can a series of unwise decisions rebut the presumption of mental capacity? Is coercion ever justified in order to enable an assessment of a person's capacity?



- Should capacity assessment be guided by any conception of good, rational, wise or non-pathological decision-making? In particular, what does it mean to require abilities to 'use or weigh' relevant information (MCA) or to 'reason' and 'appreciate' (MacCAT-T)?



- Does the UN Convention on the Rights of Persons with Disabilities require revising or abolishing mental capacity legislation? Will 'functional' conceptions of mental capacity inevitably collapse into discriminatory 'status'-based tests?

Networking between practitioners who attended allowed them to share best practice when making capacity assessments. The workshop also led to requests from practitioners for formal training from the Essex Autonomy Project.
Year(s) Of Engagement Activity 2012
 
Description Community Care on-line blog 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact EAP researcher, Viv Ashley, was invited to contribute to the Community Care blog on Adult Care. In her guest post, Viv focused on the outcomes of the EAP workshop on autonomy and responsibility in social welfare .Access to welfare is increasingly dependent on people's behaviour, on the grounds that this promotes responsibility. However, this penalises people for factors beyond their control and erodes responsibility.

http://www.communitycare.co.uk/blogs/adult-care-blog/2012/05/support-not-coercion-is-the-route-to-moral-responsibility/
Year(s) Of Engagement Activity 2012
URL http://www.communitycare.co.uk/blogs/adult-care-blog/2012/05/support-not-coercion-is-the-route-to-mo...
 
Description Consent at an Impasse Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact A two-day interdisciplinary workshop at the University of Essex, 26-27 November 2010.

Our goal in this workshop is to confront some of the fundamental problems facing the idea of consent, both in theory and in legal, clinical and civil practice.

The workshop brought together psychiatrists, philosophers, lawyers and historians to explore these and other issues regarding consent. As well as the presentation of papers, the workshop included sessions to think through case study materials which participants had an opportunity to study in advance.

The workshop led to the development of training materials for social care practitioners on issues surrounding consent, which the research team delivered to several local government teams.
Year(s) Of Engagement Activity 2010
 
Description Court of Protection Practitioners Association Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Wayne Martin was invited to give a keynote presentation at the CoPPA annual conference.
Year(s) Of Engagement Activity 2016
 
Description IMCA Conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Wayne Martin was invited to give a presentation at the IMCA conference hosted by Empowerment Matters.
Year(s) Of Engagement Activity 2016
 
Description Is there a conception of autonomy that is: Defensible in Theory and Workable in Practice? 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Are any conceptions of autonomy defensible in theory and workable in practice? At the Essex Autonomy Project, this has been a key question animating our work. In this international conference - the culmination of our major programme of events - this was addressed head on with contributions from philosophers, lawyers, psychiatrists and other practitioners.

Among the issues discussed were be philosophical disputes about theories of autonomy, developments in mental health and capacity law, and autonomy in the context of eating disorders. A set-piece debate was also be held, exploring the contested implications of the UN Convention on the Rights of Persons with Disabilities for reform of regimes of legal capacity with contributions from Gordon Ashton (District Judge and Court of Protection) and Genevra Richardson (Professor of Law, King's College London).

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Year(s) Of Engagement Activity 2013
 
Description Japanese delegation visit to the CQC 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Wayne Martin was invited by the Quality Care Commission to participate in a visit from mental health policy-makers and senior psychiatrists from Japan who visited the UK. Martin presented on 'risk, autonomy and thresholds for intervention'.
Year(s) Of Engagement Activity 2016
 
Description Maudsley Masterclass 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Open to doctors and other practising clinicians, this Masterclass was a one day training course on mental capacity given by leading clinicians and ethicists in the field. It covered the big picture of the Mental Capacity Act (2005), the parts of the law that are most relevant to clinicians, and interactive teaching on mental capacity and best interests assessment in real clinical cases. Teaching was provided by Wayne Martin and Fabian Freyenhagen from the EAP.

The Masterclass was very well received by participants and, on request from those that attended, is now run as an annual event.
Year(s) Of Engagement Activity 2012
 
Description Mental disability, state power and the capacity to decide 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Can the state force a mentally disabled woman to use contraception? How should a judge decide whether a woman in an abusive relationship has the capacity to make decisions about her own body? What is the role played by other people when we make a decision for ourselves? Wayne Martin authored an article in The Guardian to discuss these issues in light of a Court of Protection Ruling on autonomy in a case relating to the capacity to make decisions about contraception in those with learning disabilities.



http://www.guardian.co.uk/commentisfree/2010/aug/20/mental-health

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Year(s) Of Engagement Activity 2010
URL http://www.guardian.co.uk/commentisfree/2010/aug/20/mental-health
 
Description Normative Neutrality and the Theory of Autonomy 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The ideal of human autonomy has long been beset by a dilemma. On the one hand, respect for individual autonomy seems to require a kind of normative neutrality: the decisions of competent individuals ought to be respected, whether or not the decision is endorsed by others. But on the other hand, respect for autonomy seems to go hand-in-hand with (and perhaps requires) other substantive values. Where autonomy is wholly divorced from other values, it can be hard to see what is worth valuing about it. The dilemma continues to divide theorists of autonomy, but it also plays out on the frontline of professional practice and public policy. For instance, in seeking to enable vulnerable individuals to decide for themselves about their living arrangements, medical treatment, finances and research participation, the Mental Capacity Act states that "a person is not to be treated as unable to make a decision merely because he makes an unwise decision." But in practice, when someone consistently makes decisions that others deem to be seriously opposed to their best interests, this is likely to lead to their mental capacity being questioned. Furthermore, respect for autonomy often has to be achieved within legal, medical and social welfare environments which already incorporate strong presumptions about what would be beneficial for individuals. The Essex Autonomy Project workshop explored these dilemmas.

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Year(s) Of Engagement Activity 2011
 
Description Paternalism and Coercion 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The aim of the workshop is to bring together academics and practitioners with expertise on theoretical and practical issues surrounding the issue of paternalism. Increasingly, frontline professionals in medicine and social welfare, etc., find themselves working in contexts where paternalistic practices come into tension with legal and moral commitments to recognise the autonomy of individuals. Both in theory and in practice, autonomy and paternalism are often understood to stand in a classic zero-sum relation: more paternalism means less autonomy, and vice versa. This raises the question of how best to strike the proper balance between the two. But in some sense paternalism and autonomy seem to be capable of standing together, as when parents act to foster the autonomy of their children. Our hope is to facilitate an exchange of ideas across disciplinary boundaries to explore these and related issues.

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Year(s) Of Engagement Activity 2011
 
Description Philosophers are helping doctors with dilemmas over life-and-death decisions 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Wayne Martin was interviewed by the Guardian on the work of the Essex Autonomy Project and in particular how the project's research was helping medical and social care professionals.

http://www.guardian.co.uk/education/2010/jun/29/mental-health-patients-decisions

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Year(s) Of Engagement Activity 2010
URL http://www.guardian.co.uk/education/2010/jun/29/mental-health-patients-decisions
 
Description Public Lecture: Autonomy and Schizophrenia: Reflections on an Ideal 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Professor Louis Sass was invited to give a public lecture, hosted by the Essex Autonomy Project. His subject was on autonomy and schizophrenia.

Louis Sass has strong interdisciplinary interests involving the intersection of clinical psychology with philosophy, the arts, and literary studies. His publications include critical analyses of psychoanalytic theory; phenomenological studies of schizophrenia; and articles on notions of truth and of the self in psychoanalysis, hermeneutic philosophy, and postmodernism. He is the author of "Madness and Modernism: Insanity in the Light of Modern Art, Literature, and Thought" and "The Paradoxes of Delusion: Wittgenstein, Schreber, and the Schizophrenic Mind." He also co-edited "Hermeneutics and Psychological Theory." Dr. Sass has been a member of the Institute for Advanced Studies in Princeton, N.J., and was awarded fellowships from the National Endowment for the Humanities and the Fulbright Foundation. Currently he is a fellow of the New York Institute for the Humanities and a research associate in the history of psychiatry at Cornell Medical College. He is also a research associate in the Center for Cognitive Science and serves on the faculty of the Program in Comparative Literature, both at Rutgers. In 1998-99 he was president of the Division of Psychology and the Arts of the American Psychological Association. In 2006-07, he was president of the Division of Theoretical and Philosophical Psychology of APA.

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Year(s) Of Engagement Activity 2013
 
Description Public Lecture: Freedom's Right: An Outline of Democratic Ethical Life 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact Axel Honneth from the Goethe-Universität Frankfurt, Institut für Philosophie gave a public lecture in the Philosophy Department on the theme of the democratic, ethical life.

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Year(s) Of Engagement Activity 2011
 
Description The (Vexed and Contentious) History of Autonomy 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The first conference organised by the Essex Autonomy Project, this event explored the history of autonomy through presentations by the following speakers:

Continuity in the History of Autonomy, Terence Irwin (University of Oxford)

The Ethics of Freedom, Tom Pink (KCL, London)

Autonomy as an End: Kant, Schiller and the Law, Katerina Deligiorgi (University of Sussex)

Appropriating Freedom: Freud's Concept of Autonomy, Axel Honneth (University of Frankfurt)

Death, Life and Autonomy in Antigone, David McNeill (University of Essex)

Rousseau on the Origins of Autonomy Theory, Frederick Neuhouser (Columbia University)

Reason's Form, Robert Pippin (University of Chicago)

What Can or Should Autonomy Do For Liberty?, John Skorupski (University of St Andrews)

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Year(s) Of Engagement Activity 2010
 
Description Understanding Others 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The aim of this particular workshop was to bring together academics and practitioners with expertise in phenomenology and psychiatry, in order to explore areas of common interest and facilitate exchange of ideas across disciplinary boundaries, and between theory and practice. A number of our psychiatric partners are looking for ways to integrate phenomenological research methods into psychiatric studies, while our colleagues in phenomenology are interested in ways of expanding phenomenological research beyond its traditional first-person orientation. Here are a few of the specific questions we addressed:

•What is the theoretical basis for phenomenological investigation of the experiences of other people?

•How can the techniques of clinical psychiatry be integrated into the traditional methods of phenomenology?

•Can phenomenological research methods provide reliable data within the paradigm of 'evidence-based scientific medicine'?

•How might our understanding of particular psychiatric disorders (depression, schizophrenia, dementia, etc.) be enhanced through utilisation of insights drawn from the phenomenological tradition?

The workshop increased networking between psychiatrists and phenomenological researchers and led to increased co-operation between the fields. Researchers from the EAP were invited to address informal meetings of psychiatrists.
Year(s) Of Engagement Activity 2011
 
Description Was Autonomy the Wrong Ideal? 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Type Of Presentation paper presentation
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A key question for the Essex Autonomy Project is whether, and in what sense, autonomy is an appropriate ideal in human affairs. It is very often taken for granted that individual autonomy is a good worth pursuing, perhaps a very basic good. But at the same time it is clear that the ideal is contentious. Indeed it is no exaggeration to say that in recent times the very idea of autonomy has come under sustained attack. For example: Feminists and ecological thinkers have alleged that modern moral and legal schemes vastly overvalue autonomy at the expense of attachment, embeddedness and receptivity. Marxists have challenged the very notion of autonomy as a politically expedient fiction, while post-structuralists have insisted that the ideal is irremediably tainted by an untenable conception of the self-sufficient rational subject. Reductionists and eliminativists have argued that the notion is a residue of folk psychology or an antiquated mind-body dualism. Heideggerians have argued that the elevation of the ideal of autonomy inexorably leads towards nihilism.

The aim of this conference was to better understand and assess these and related criticisms. One test for any proposed theory of autonomy is to consider whether and how it might stand up to the most powerful criticisms that have been directed against the ideal. By considering whether and how the criticisms might be answered, we can squarely face the troubling question of whether autonomy can be a suitable ideal for finite, dependent, embodied creatures like ourselves.

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Year(s) Of Engagement Activity 2011