Abstract
Hughes and Fulford discuss the ethical challenges posed by different definitions of personhood [1]. This is particularly important when considering people with mental-health problems, as definitions relying on reason, reflective capacity or narrative coherence can, in a philosophical sense, threaten the position of our patients as people. For example, if human rights are granted on the basis of humanness, and humanness is defined on the basis of rationality, then individuals with severe psychosis and extreme thought disorder are excluded from human rights. Similarly, children are excluded, as they lack the cognitive capacity of mature, psychologically well adults.
I would like to draw attention to Nussbaum's philosophical approach [2], which may benefit those with mental illness. She asks what features of a life determine that it is worthy of the dignity of human life. Her answer emphasizes ‘central human capabilities’ – a list of interrelated features that determine one's capacity for a ‘good life’. They are: (i) life, (ii) bodily health, (iii) bodily integrity, (iv) being able to use the senses, to imagine, think and reason, (v) emotions, (vi) practical reason, (vii) affiliation (which includes the ability to engage in social interactions and having the social base of selfrespect and non-humiliation), (viii) being able to live with other species, (ix) play, and (x) control over one's environment.
Nussbaum expands a theory of social justice: society has a duty to allow central human capabilities to flourish. For example, the capability of affiliation includes having the social bases of self-respect and non-humiliation; being able to be treated as a dignified being whose worth is equal to others. Society's duty in relation to this is to provide for non-discrimination on the basis of race, sex, sexual orientation, ethnicity, caste, religion and national origin.
Nussbaum argues that society has a duty to maximize the opportunities for those with any kind of disability, including mental illness, to reach their full potential capabilities. This would involve extra funding, medical care, legislative protections, education, vocational support and social support for those with mental illness. Rather than being excluded from certain rights because of disability, the individual's disability confers on society the duty to provide extra support to maximize that person's capabilities. Nussbaum explains the implications of her theory using examples of individuals with Down's syndrome, Aspergers and Tourette's, and Severe Mental Retardation.
Nussbaum's theory of social justice differs from many of the traditional views in that it is inclusive of those with disability.
Nussbaum's human capabilities approach is relevant in considering the ethics of autonomy, treatment and involuntary treatment [3, 4]. Her theory offers a justification of involuntary treatment and a minimal model of guardianship as a way of society ensuring it assists individuals to reach their human capabilities.
Nussbaum also argues that society has a duty to carers to allow them to reach their potentials. Again, this requires real support and, it could be argued, allows involuntary treatment of those with severe mental illness to ease some of their carer's burden.