Acad Psychiatry. 2026 Apr 17. doi: 10.1007/s40596-026-02342-8. Online ahead of print.
ABSTRACT
This viewpoint challenges the conventional, static understanding of decision-making capacity in addiction psychiatry. Drawing on clinical experience and ethical theory, it argues that capacity is not a fixed, binary construct but rather a fluctuating and context-dependent process shaped by neurobiology, environment, and social conditions. Substance use disorders disrupt cognitive and affective systems, producing instability in judgment that is not adequately captured by traditional models focused on discrete assessments. The paper advances a temporal and relational framework of capacity, emphasizing trajectory, support systems, and the conditions necessary for meaningful autonomy. It also considers policy implications, including the ethical justification for time-limited involuntary interventions aimed at restoring agency. Ultimately, the article calls for a reframing of autonomy and capacity as dynamic processes embedded in care, rather than isolated moments of decision-making.
PMID:41998352 | DOI:10.1007/s40596-026-02342-8
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