Ulysses in the United Kingdom: Difficulties with a capacity‐based justification for self‐binding in bipolar disorder

Summary There has been a recent proposal by Gergel and Owen for introduction of legally enforceable self‐binding directives for persons with bipolar affective disorder in the United Kingdom. The model is rooted in presence or absence of decision‐making capacity, and the notion of capacity used is an expansion of the usual notion of capacity, in that it is individualized and diachronic. In this article, I argue that an individualized notion of capacity either lacks a coherent foundation or exposes itself to a situation where epistemological error results in a double standard or unjustified enforcement of the directive. I also raise concern that the diachronic notion of capacity leads to an authenticity type account, which fails to incorporate differences in individual prognosis. I then present a rough sketch of an alternative account, more in keeping with current mental health legislation, which uses an individualized notion of “risk to self” to justify self‐binding directives in bipolar disorder.