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Freedom to negotiate: a proposal extricating ‘capacity’ from ‘consent’

Published online by Cambridge University Press:  15 February 2017

Liz Brosnan  and
Eilionóir Flynn
Liz Brosnan*
Affiliation:
Centre for Disability Law and Policy, NUI Galway, Ireland. E-mail: liz.brosnan@nuigalway.ie; eilionoir.flynn@nuigalway.ie.
Eilionóir Flynn
Affiliation:
Centre for Disability Law and Policy, NUI Galway, Ireland. E-mail: liz.brosnan@nuigalway.ie; eilionoir.flynn@nuigalway.ie.
*
liz.brosnan@nuigalway.ie
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Abstract

In this paper, we seek to radically reframe the legal construct of consent from a disability perspective. Drawing on feminist scholarship and human rights standards around ‘free and informed consent’, we apply a concept of freedom to negotiate to laws regulating both consent to sex and medical treatment – key areas in which the legal agency of people with disabilities (especially people with cognitive disabilities) is routinely denied, restricted or ignored. We set out the essential ingredients for reframing consent: namely, legal personhood, freedom to negotiate and understanding. We also outline conditions (i.e. coercion, undue influence and power imbalances) that impede valid consent. This represents a first attempt to move beyond labelling adults with certain disabilities as lacking the ‘mental capacity’ necessary to give valid consent – in order to explore in more depth particular expressions of consent or refusal and seek new validity criteria, beyond the label of ‘mental incapacity’.

Information

Type
Articles
Information
International Journal of Law in Context , Volume 13 , Special Issue 1: Legal Capacity and Human Rights , March 2017 , pp. 58 - 76
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

We wish to thank the two anonymous reviewers for their helpful comments and feedback on an earlier draft of this paper, along with the following colleagues who provided helpful insights on previous drafts: Anna Arstein-Kerslake, Tina Minkowitz, Alex Ruck-Keene, Elizabeth Kamundia, Kristijan Grdan, Maths Jesperson, Piers Gooding and Michelle Browning. Any errors or inaccuracies are the sole responsibility of the authors.

References

Alexander, Larry (1996) ‘The Moral Magic of Consent (II)’, Legal Theory 2: 165–174.Google Scholar
Anderson, Michelle (2004) ‘Negotiating Sex’, Southern California Law Review 78: 1401–1438.Google Scholar
Arstein-Kerslake, Anna (2015) ‘Understanding Sex: The Right to Legal Capacity to Consent to Sex’, Disability and Society 30(10): 1459–1473.Google Scholar
Arstein-Kerslake, Anna and Flynn, Eilionóir (2016) ‘Legislating Consent: Creating an Empowering Definition of Consent to Sex that Is Inclusive of People with Cognitive Disabilities’, Social & Legal Studies 25 (2): 225–248.Google Scholar
Arstein-Kerslake, Anna and Flynn, Eilionóir (2017) ‘The Right to Legal Agency: Domination, Disability, and the Protections of Article 12 of the Convention on the Rights of Persons with Disabilities’, International Journal of Law in Context 13(1): 22–38.Google Scholar
Baker, Sarah R., Precilla, Y.L., Henshaw, Carol A. and Tree, Joanne (2005) ‘“I Felt as though I'd Been in Jail”: Women's Experiences of Maternity Care during Labour, Delivery and the Immediate Postpartum’, Feminism & Psychology 15: 315–342.Google Scholar
Beres, Melanie A. (2007) ‘“Spontaneous” Sexual Consent: An Analysis of Sexual Consent Literature’, Feminism & Psychology 17: 93–108.Google Scholar
Björnsdóttir, Kristin and Traustadóttir, Rannveig (2010) ‘Stuck in the Land of Disability? The Intersection of Learning Difficulties, Class, Gender and Religion’, Disability and Society 25: 49–62.Google Scholar
Brophy, L.M., Roper, C.E., Hamilton, B.E., Tellez, J.J. and MCSHERRY, B.M. (2016) ‘Consumers and Their Supporters' Perspectives on Poor Practice and the Use of Seclusion and Restraint in Mental Health Settings: Results from Australian Focus Groups’, International Journal of Mental Health Systems 10: 1–10.Google ScholarPubMed
Brosnan, Liz (2012) ‘Power and Participation: An Examination of the Dynamics of Mental Health Service-User Involvement in Ireland’, Studies in Social Justice 6: 45–66.Google Scholar
Brownmiller, Susan (2013) Against Our Will: Men, Women and Rape. New York: Open Road Media.Google Scholar
Burkett, Melissa and Hamilton, Karine (2012) ‘Postfeminist Sexual Agency: Young Women's Negotiations of Sexual Consent’, Sexualities 15: 815–833.Google Scholar
Burns, Tom, Yeeles, Ksenija, Molodynski, Andrew, Nightingale, Helen, Vazquez-Montes, Maria, Sheehan, Kathleen and Linsell, Louise (2011) ‘Pressures to Adhere to Treatment (“Leverage”) in English Mental Healthcare’, British Journal of Psychiatry 199: 145–150.Google Scholar
Burstow, B. (2015) Psychiatry and the Business of Madness: An Ethical and Epistemological Accounting. Cham, Switzerland: Springer.Google Scholar
Costa, Lucy (2013) ‘Mad Patients as Legal Interveners in Court’ in LeFrançois, Brenda, Menzies, Robert and Reaume, Geoffery (eds) Mad Matters: A Critical Reader in Canadian Mad Studies. Toronto: Canadian Scholars Press Inc., 195–209.Google Scholar
Cowart, Monica R. (2004) ‘Understanding Acts of Consent: Using Speech Act Theory to Help Resolve Moral Dilemmas and Legal Disputes’, Law and Philosophy 23(5): 495–525.Google Scholar
Curkovic, Mario, Dodig-Ćurković, Katarina, Erić, Anamarija Petek, Kralik, Kristina and Pivac, Nela (2016) ‘Psychotropic Medications in Older Adults: A Review’, Psychiatria Danubina 28: 13–24.Google ScholarPubMed
Dawson, John Bernard (2005) Community Treatment Orders: International Comparisons. Dunedin: Otago University Print.Google Scholar
De Bhailís, Clíona and Flynn, Eilionóir (2017) ‘Recognising Legal Capacity: Commentary and Analysis of Article 12 CRPD’, International Journal of Law in Context 13(1): 6–21.CrossRefGoogle Scholar
Diesfeld, Kate and Sjöström, Stefan (2007) ‘Interpretive Flexibility: Why Doesn't Insight Incite Controversy in Mental Health Law?’, Behavioral Sciences and the Law 25: 85–101.Google Scholar
Dripps, Donald (1992) ‘Beyond Rape: An Essay on the Difference between the Presence of Force and the Absence of Consent’, Columbia Law Review 92: 1780–1809.CrossRefGoogle Scholar
Dripps, Donald (1996) ‘For a Negative, Normative Model of Consent, with a Comment on Preference-Skepticism’, Legal Theory 2: 113–120.Google Scholar
Dunn, Michael, Maughan, Daniel, Hope, Tony, Canvin, Krysia, Rugkåsa, Jorun, Sinclair, Julia and Burns, Tom (2012) ‘Threats and Offers in Community Mental Healthcare’, Journal of Medical Ethics 38: 204–209.Google Scholar
Dunn, Michael C., Clare, Isabel C.H. and Holland, Anthony J. (2008) ‘Substitute Decision-Making for Adults with Intellectual Disabilities Living in Residential Care: Learning through Experience’, Health Care Analysis 16: 52–64.Google Scholar
Dutoit, Louise (2007) ‘The Conditions of Consent’ in Hunter, Rosemary and Cowan, Sharon (eds) Choice and Consent: Feminist Engagements with Law and Subjectivity. Abingdon, New York: Routledge-Cavendish, 58–73.Google Scholar
Flynn, Eilionóir and Arstein-Kerslake, Anna (2014) ‘Legislating Personhood: Realising the Right to Support in Exercising Legal Capacity’, International Journal of Law in Context 10(1): 81–104.Google Scholar
Flynn, Eilionóir and Arstein-Kerslake, Anna (2017) ‘State Intervention in the Lives of People with Disabilities: The Case for a Disability Neutral Framework’, International Journal of Law in Context 13(1): 39–57.Google Scholar
Fundamental Rights Agency (2013) Legal Capacity of Persons with Intellectual Disabilities and Persons with Mental Health Problems. Luxembourg: Publications of the Office of the European Union.Google Scholar
Fyson, Rachel and Cromby, John (2013) ‘Human Rights and Intellectual Disabilities in an Era of “Choice”’, Journal of Intellectual Disability Research 57: 1164–1172.Google Scholar
Gaventa, John (2006) ‘Finding the Spaces for Change: A Power Analysis’, IDS Bulletin 37: 23–33.Google Scholar
Gooding, Piers and Flynn, Eilionóir (2015) ‘Querying the Call to Introduce Mental Capacity Testing to Rights-Based Mental Health Law’, Laws: Special Issue ‘Competency and Capacity: Issues Affecting Health Law, Policy and Society’ 4: 245–271.Google Scholar
Goodley, Dan and Lawthom, Rebecca (eds) (2005) Disability and Psychology: Critical Introductions and Reflections. Houndsmills, Basingstoke, Hampshire: Palgrave Macmillan.Google Scholar
Haidt, Jonathan (2001) ‘The Emotional Dog and Its Rational Tail: A Social Intuitionist Approach to Moral Judgment’, Psychological Review 108(4): 814.Google Scholar
Hamilton, Bridget and Roper, Cath (2006) ‘Troubling “Insight”: Power and Possibilities in Mental Health Care’, Journal of Psychiatric and Mental Health Nursing 13: 416–422.Google Scholar
Health Service Executive (HSE) (2006) Leas Cross Review. Available at: <http://www.hse.ie/eng/services/Publications/olderpeople/Leas_Cross_Report.html> (accessed 9 October 2015).+(accessed+9+October+2015).>Google Scholar
Herring, Jonathan (2012) ‘Mental Disability and Capacity to Consent to Sex: A Local Authority v H [2012] EWHC 49 (COP)’, Journal of Social Welfare and Family Law 34: 471–478.Google Scholar
Holmes, Helen B. and Purdy, Laura M. (1992) Feminist Perspectives in Medical Ethics. Bloomington, IN: Indiana University Press.Google Scholar
Hunter, Rosemary and Cowan, Sharon (eds) (2009) Choice and Consent: Feminist Engagements with Law and Subjectivity. Abingdon, New York: Routledge-Cavendish.Google Scholar
Hurd, Heidi (1996) ‘The Moral Magic of Consent’, Legal Theory 2: 121–146.Google Scholar
Iyengar, Sheena S. and Lepper, Mark R. (2000) ‘When Choice Is Demotivating: Can One Desire Too Much of a Good Thing?’, Journal of Personality and Social Psychology 79(6): 995.Google Scholar
Jenkinson, Josephine C. (1993) ‘Who Shall Decide? The Relevance of Theory and Research to Decision-Making by People with an Intellectual Disability’, Disability, Handicap and Society 8: 361–375.Google Scholar
Kaminskiy, Emma (2015) ‘The Elephant in the Room: A Theoretical Examination of Power for Shared Decision Making in Psychiatric Medication Management’, Intersectionalities: A Global Journal of Social Work Analysis, Research, Polity, and Practice 4: 19–38.Google Scholar
Kanter, Arlene S. (2014) The Development of Disability Rights under International Law. Abingdon, New York: Routledge.Google Scholar
Kayess, Rosemary and French, Phillip (2008) ‘Out of Darkness Into Light: Introducing the Convention on the Rights of Persons with Disabilities’, Human Rights Law Review 8(1): 1–34.Google Scholar
Lehman, Jeffrey and Phelps, Shirelle (2005) West's Encyclopedia of American Law. Detroit: Thomson/Gale.Google Scholar
Lidz, Charles W., Mulvey, Edward P., Hoge, Steven K., Kirsch, Brenda L., Monahan, John, Eisenberg, Marlene, Gardner, William and Roth, Loren H. (1998) ‘Factual Sources of Psychiatric Patients’ Perceptions of Coercion in the Hospital Admission Process’, American Journal of Psychiatry 155: 1254.Google Scholar
Lord, Janet E. and Stein, Michael A. (2013) ‘Contingent Participation and Coercive Care: Feminist and Communitarian Theories of Disability and Legal Capacity’ in McSherry, Bernadette and Freckelton, Ian (eds) Coercive Care: Rights, Law and Policy. Oxon and New York: Routledge 31–47.Google Scholar
Lukes, Stephan (1974) Power: A Radical View. London: Macmillan.Google Scholar
Mackinnon, Catherine (1997) ‘Rape: On Coercion and Consent’ in K. Conboy, N. Medina and S. Stanbury (eds) Writing on the Body: Female Embodiment and Feminist Theory. New York: Columbia University Press, 42–58.Google Scholar
Mackinnon, Catherine A. (1991) ‘Reflections on Sex Equality under Law’, Yale Law Journal 100(5), Centennial Issue (March 1991): 1281–1328.Google Scholar
Malm, Heidi M. (1996) ‘The Ontological Status of Consent and Its Implications for the Law on Rape’, Legal Theory 2: 147–164.Google Scholar
Masterson, Steve and Owen, Sara (2006) ‘Mental Health Service User's Social and Individual Empowerment: Using Theories of Power to Elucidate Far-Reaching Strategies’, Journal of Mental Health 15: 19–34.Google Scholar
Mcsherry, B. and Freckelton, I. (2013) Coercive Care: Rights, Law and Policy. Oxon and New York: Routledge.Google Scholar
Mead, Sheri (2007) ‘Trauma-Informed Peer Run Crisis Alternatives’ in Stastny, Peter and Lehmann, Peter (eds) Alternatives Beyond Psychiatry. Berlin, Eugene, Shrewsbury: Peter Lehmann Publishing.Google Scholar
Mead, Sheri and Hilton, David (2003) ‘Crisis and Connection’, Psychiatric Rehabilitation Journal 27(1): 87–94.Google Scholar
Minkowitz, Tina (2007) ‘The United Nations Convention on the Rights of Persons with Disabilities and the Right to Be Free from Nonconsensual Psychiatric Interventions’, Syracuse Journal of International Law and Commerce 34: 405–411.Google Scholar
Morant, Nicola, Kaminskiy, Emma and Ramon, Shulamit (2015) ‘Shared Decision Making for Psychiatric Medication Management: Beyond the Micro-Social’, Health Expectations, doi: 10.1111/hex.12392.Google Scholar
Morgan, Derek and Veitch, Kenneth (2004) ‘Being Ms B: B, Autonomy and the Nature of Legal Regulation’, Sydney Law Review 26: 107–130.Google Scholar
Morrison, Anthony P., Hutton, Paul, Shiers, David and Turkington, Douglas (2012) ‘Antipsychotics: Is It Time to Introduce Patient Choice?’, British Journal of Psychiatry 201(2): 83–84.Google Scholar
Morrissey, Fiona (2012) ‘The United Nations Convention on the Rights of Persons with Disabilities: A New Approach to Decision-Making in Mental Health Law’, European Journal of Health Law 19(5): 423–440 CrossRefGoogle ScholarPubMed
Newbigging, Karen, Ridley, Julie, McKeown, Mick, Sadd, June, Machin, Karen, Cruse, Kaaren, Dela Haye, Stephanie, Able, Laura and Poursanidou, Konstantina (2015) Independent Mental Health Advocacy: The Right to Be Heard. London, Jessica Kingsley.Google Scholar
Palmer, Tanya (2013) Sex and Sexual Violation in the Criminal Law: Findings from a Study into How People Distinguish Sex from Sexual Violation. University of Bristol: ESRC. Available at: https://tanyavpalmer.files.wordpress.com/2013/04/sex-and-sexual-violation-in-the-criminal-law-june-2013.pdf (accessed 12 January 2017).Google Scholar
Parsons, Tallcott (1963) ‘On the Concept of Influence’, Public Opinion Quarterly 27: 37–62.CrossRefGoogle Scholar
Quinn, Mary Joy (2000) ‘Undoing Undue Influence’, Journal of Elder Abuse & Neglect 12: 9–17.Google Scholar
Schulhofer, Stephen J. (1998) Unwanted Sex: The Culture of Intimidation and the Failure of Law, vol. 99 . London: Harvard University Press.Google Scholar
Series, Lucy (2012) ‘Some Thoughts on Recent Developments in Right to Die Case Law’. Available at: https://thesmallplaces.wordpress.com/2012/06/22/some-thoughts-on-recent-developments-in-right-to-die-case-law/ (accessed 12 January 2017).Google Scholar
Sjöström, Stefan (2006) ‘Invocation of Coercion Context in Compliance Communication: power Dynamics in Psychiatric Care’, International Journal of Law and Psychiatry 29: 36–47.Google Scholar
Spandler, Helen, Anderson, Jill and Sapey, Bob (eds) (2015) Madness, Distress and the Politics of Disablement. Bristol: Polity Press.Google Scholar
Stefan, Susan (1992) ‘Silencing the Different Voice: Competence, Feminist Theory and Law’, University Miami Law Review 47: 763–815.Google Scholar
Strand, Marie Louise, Benzein, Eva and Saveman, Britt-Inge (2004) ‘Violence in the Care of Adult Persons with Intellectual Disabilities’, Journal of Clinical Nursing 13: 506–514.Google Scholar
Thomas, Phillip (2014) Psychiatry in Context Experience, Meaning & Communities. Monmouth: PCCS Books.Google Scholar
Un Committee on the Rights of Persons with Disabilities (CRPD COMMITTEE) (2014) General Comment No. 1, Article 12 2014: Equal Recognition Before the Law, Paragraph 25, UN, UN Doc. No. CRPD/C/GC/1 (April 2014).Google Scholar
Un Committee on the Rights of Persons with Disabilities (CRPD COMMITTEE) (2015) Guidelines on Article 14 of the Convention on the Rights of Persons with Disabilities: The Right to Liberty and Security of Persons with Disabilities: Adopted During the Committee's 14th Session, September 2015.Google Scholar
UNCRPD COMMITTEE (2000) General Comment 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant), UN Doc. No. E/C.12/2000/4 (August 2000).Google Scholar
Warme, Gordon (2013) ‘Removing Civil Rights: How Dare We?’ in LeFrançois, Brenda, Menzies, Robert and Reaume, Geoffery (eds) Mad Matters: A Critical Reader in Canadian Mad Studies. Toronto: Canadian Scholars Press Inc., 210–220.Google Scholar
West, Robin (2010) ‘Sex, Law and Consent’ in Miller, Franklin and Wertheimer, Anthony (eds) The Ethics of Consent: Theory and Practice. Oxford: Oxford University Press, 221–550.Google Scholar
Zigmond, Tony (2011) ‘Pressures to Adhere to Treatment: Observations on “Leverage” in English Mental Healthcare’, British Journal of Psychiatry 199: 90–91.Google Scholar