The purpose of this article is to examine the concept of fluctuating capacity and its intricacies, identifying the issues that can inform the development of provisions in this area. The paper seeks to challenge the current binary approach applied in this context by showing that the lack of legal principles governing the concept of fluctuating capacity renders people in this category vulnerable to being denied autonomy. It proposes a conceptual definition for the determination of fluctuating capacity and suggests the use of self-binding directives as a measure to overcome the setbacks of the binary approach. The paper also proposes expanding the application of self-binding directives to include a wider scope of disorders with episodic features, adding to the debate on the autonomy and rights of people with bipolar disorder. The ethical justification for adopting self-binding directives in this context is the safeguarding of autonomy when individuals prefer to extend their autonomy beyond moments of incapacity.
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