Accounting for Intuition in Decision-Making Capacity: Rethinking the Reasoning Standard?

Given the ethical implications of assessments of decision-making capacity, adequate definitions and appropriate assessment criteria are essential, especially with regard to clinical practice in psychiatry. Currently applied standards have been criticized for emphasizing exclusively cognitive abilities. In particular, the present paper questions the adequacy of the current reasoning criterion. Referring to dual-process models of decision making, it is argued that the reasoning standard embraces only one side of the duality that is rational deliberation, and fails to take proper account of intuitive decision making. An outline of intuition’s potency in health care decisions informs the present account of why the current reasoning standard fails to take adequate account of patients’ decision-making preferences and of major deficits in intuitive reasoning. Toward a more comprehensive understanding, a possible reconceptualization of reasoning as the ability to decision-related self-reflection is advanced, and implications for evaluation, challenges, and limitations are discussed.