Patient narrative: an ‘on-switch’ for evaluating best interests

Abstract

This article examines how the wishes, feelings, values and beliefs of adults lacking capacity can be evaluated and the extent to which they are given effect in best interests' decisionmaking. One way of fulfilling the clinician's legal responsibilities to take a patient's preferences into account is to explicitly link these to the notion of narrative. Narratives provide a compelling grounding and give weight to views and values that may have been informally and consistently expressed in the past. An evaluation of recent case law suggests that the trajectory of a person's life, their character and personality, and the perspectives of those with whom the patient has valued relationship are given increasing judicial recognition.Attending to the narrative of the patient could lead to a more sophisticated judgement of best interests than an objective 'balance sheet' approach would allow and enable greater alignment with the UN Convention on the Rights of Persons with Disabilities.

The Mental Capacity Act: 10 years on – the key learning areas for healthcare professionals

“…Ultimately, the concept of shared decision making will only be successful if health care professionals acknowledge and accept that while patients often make decisions thought to be the "right" ones, they also have the right to make decisions that health care professionals may view as the "wrong" ones. 18,19 Nevertheless, as Lennard 15 notes, it can be a stressful time for health care professionals when patients make unwise choices that carry a potential risk of significant harm to well-being.…”

Psychosis and identity: Alteration or loss?

“…13 Johnston et al give a "non-technical" definition of "narrative" as "an instantiation of the beliefs, values, experiences, actions, decisions, events and relationships that give meaning and coherence to a person's life." 14 For many accounts of narrative identity, it is overall coherence which is the foundation of stable identity and, as some argue, the basis of psychological well-being. 15 With *Parfit does suggest that we can remain committed to the 'same person', if there are temporary periods when they 'are not of a sound mind'.…”

“…Another model of identity, which has roots in psychology, is the theory of narrative identity. This is the notion that the self is constituted by the “internalized and evolving story of the self that a person constructs to make sense and meaning out of his or her life.” As Schechtman says, of the most basic narrativist view: “our actions must be meaningful and significant in a way that cannot be captured in purely naturalistic terms, but requires that we interpret our behaviours in the context of a narrative.” Johnston et al give a “non‐technical” definition of “narrative” as “an instantiation of the beliefs, values, experiences, actions, decisions, events and relationships that give meaning and coherence to a person's life.” For many accounts of narrative identity, it is overall coherence which is the foundation of stable identity and, as some argue, the basis of psychological well‐being . With or without the normative claim, selfhood resides in some fundamental narrative unity or integrity stretching across my life, as understood from a later vantage point.…”