Tiredness and the Capacity to Decide: The Example of Maternity Care.

Tiredness is taken seriously in healthcare where clinicians are concerned since good decisions require the ability to think clearly. The impact of patient tiredness is neglected. This is surprising, as there are healthcare contexts, like maternity care, where tiredness is nearly ubiquitous. Empirical research into sleep deprivation suggests that tiredness undermines substantially our abilities to understand and reason about potential choices. Since these abilities are necessary components of having capacity, tired patients may lack capacity in moments when important choices have to be made, for example a late intervention in active labour. I defend this argument. Tiredness can sometimes impair capacity and so justifies testing for capacity in some cases. Taking tiredness seriously and assessing it in practice is not paternalistic. Indeed, I argue that recognising the impact of tiredness, while failing to act on that fact, constitutes 'dependency denial' which harms women in maternity care.