We wish to advance the case for psychiatrists and other health care professionals to pursue a cautious paternalism where their patients make decisions which might be regarded as extremely harmful to themselves. This approach is in contrast with the process approach to decision making capacity judgments. The process approach does not allow judgments about decision making capacity of patients to be based upon judgments about the outcomes, values or beliefs basis of their decision making. It rules these out on two grounds: first that a process account of decision making is able to account for all aspects of decision making; and second that any other approach is normatively questionable, allowing as it must some unwarranted degree of restriction of liberty.
We endorse the alternative view that process accounts cannot adequately capture all aspects of decision making capacity, and embrace the view that inevitably judgments about the content of decisions must be made by psychiatrists in capacity assessment. Given that such judgments are inevitable if any judgement of capacity is to be made at all, we deny that such judgments must be normatively questionable or liberty restricting.