A 'Ulysses arrangement' (UA) is an agreement where a patient may arrange for psychiatric treatment or non-treatment to occur at a later stage when she expects to change her mind. In this article, I focus on 'competence-insensitive' UAs, which raise the question of the permissibility of overriding the patient's subsequent decisionally competent change of mind on the authority of the patient's own prior agreement. In "The Ethical Justification for Ulysses Arrangements", I consider sceptical and supportive arguments concerning competence-insensitive UAs, and argue that there are compelling reasons to give such UAs serious consideration. In "Decisional Competence and Legal Capacity in UAs", I examine the nature of decisional competence and legal capacity as they arise in UAs, an issue neglected by previous research. Using the distinctions which emerge, I then identify the legal structure of a competence-insensitive UA in terms of the types of legal capacity it embodies and go on to explain how types of legal capacity might be shared between the patient and a trusted other to offer support to the patient in the creation and implementation of a competence-insensitive UA. This is significant because it suggests possibilities for building patient support mechanisms into models of legal UAs, which has not addressed in the literature to date. Drawing on this, in "Using Insights from the Competence/Capacity Distinction to Enhance Patient Support in UAs", I offer two possible models to operationalize competence-insensitive UAs in law that allow for varying degrees of patient support through the involvement of a trusted other. Finally, I outline some potential obstacles implementing these models would face and highlight areas for further research.

In this paper, I develop the basis of a normative legal theory of mental health vulnerability. In Section 2, I conceptualise mental health vulnerability by integrating a universal understanding of vulnerability with a subjective-evaluative, psychosocial and dimensional account of mental health. In Section 3, I move on to consider the significance of mental health vulnerability for legal theory through an encounter with perspectives on vulnerability offered by MacIntyre, Fineman and Del Mar. This offers an insight into the normative foundations of mental health vulnerability. In Section 4, I outline a normative framework for mental health vulnerability that involves a synergy of rights and care. This extends Engster's idea of ‘a right to care’ to mental health and highlights the role of care and rights in mitigating power imbalances and inequality in relation to mental health. In concluding, I suggest future directions for research on mental health vulnerability.

No abstract

No abstract

No abstract