Explorations of the relationship between the right to make decisions and moral responsibility in healthcare Upplaga 1

People intuitively think that there is a strong connection between having a right to make decisions and to be morally responsible for those decisions. This thesis explores the relationship between these notions in the context of healthcare. The exploration particularly focuses on what I call fringe decisional agents, e.g. adolescents and people who suffer from mental disorder, who have uncertain decision-making competence and exist at the intersection of different institutions. I argue that even though the two notions are strongly connected they can come apart. First, even though both notions are concerned with the moral status of a person there is a potential conflict between the appropriate responses to a person who has the right to decide and someone who is morally responsible. Second, even if conditions for having the right to decide and being morally responsible are very similar they can come apart. Moral responsibility requires that a person exercises a certain degree of control over their actions, a condition that has no clear equivalent for the right to decide. Furthermore, even though both have cognitive conditions, the condition for having the right to decide is directed towards information regarding oneself, whereas the condition for moral responsibility is primarily directed towards information about other people. Finally, if an agent is the concern of different institutions, these might have different conditions for assigning the relevant status and may furthermore do so at different times. Parts of work I. Hartvigsson, T., Munthe, C.,& Forsander, G. (2018). Error-Trawling and Fringe Decision Competence: Ethical Hazards in Monitoring and Address Patient Decision Capacity in Clinical Practice. Clinical Ethics, 13(3), 126-136. https://doi.org/10.1177/1477750917749955 II. Munthe, C., El-Alti, L., Hartvigsson, T.,& Nijsingh, N. (2018). Disputing with Patients in Person-Centered Care: Ethical Aspects in Standard Care, Pediatrics, Psychiatry, and Public Health. Journal of Argumentation in Context, 7(2), 231-244 https://doi.org/10.1075/jaic.18022.mun III. Hartvigsson, T. and Munthe, C. (manuscript) Responsibilities in Change: Modelling Parental Authority and Children's Autonomy IV. Hartvigsson, T. (submitted) Between Punishment and Care: Autonomous Offenders Who Commit Crimes Under the Influence of Mental Disorder.