Affect, Autonomy, Authenticity, and the Assessment of Decision‐Making Capacity: The Problem of Tyrannical Coherence

ABSTRACT There are cases of psychiatric disorder where affective states produce severely self‐destructive behavior. Sufferers do not appear to be making autonomous decisions, and appear to be severely impaired in their decision‐making capacity. Suffers of these kinds of cases of these kinds of disorders fall into a “gray area” in the law. If this gray area is to be avoided, the law requires clearer criteria for determining how affect can undermine autonomy. Existing “procedural” accounts of autonomy that explicitly set out to deal with how affective states can undermine decision‐making are unable to deal with a clinically significant class of such cases. In this class of cases, autonomy is undermined by an affective state that is relevantly coherent with the rest of the person's affective states and attitudes, and has relevantly inoffensive origins. The relevant affective state nevertheless appears to “hijack” the person, and to rule over them “tyrannically.” I argue for a necessary condition on autonomy amenable to a procedural account, non‐tyranny , according to which one is autonomous with respect to a decision only if one has the ability to resist the influence of any given affective state on that decision.