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Recent legal developments challenge how valid the concept of mental capacity is in determining whether individuals with impairments can make decisions about their care and treatment. Kong defends a concept of mental capacity, but argues that such assessments must consider how relationships and dialogue can enable or disable the decision-making abilities of these individuals. This is thoroughly investigated using an interdisciplinary approach that combines philosophy and legal analysis of the law in England and Wales, the European Court of Human Rights, and the United Nations Convention on the Rights of Persons with Disabilities. By exploring key concepts underlying mental capacity, the investigation concludes that both primary relationships, as well as capacity assessments themselves, must display key competencies in order to ensure that autonomy skills are promoted and encouraged. This ultimately provides scope for justifiable interventions into disabling relationships and articulates the dialogical practices that help better situate, interpret, and understand the choices and actions of individuals with impairments.

Background Research involving adults who lack the capacity to provide informed consent can be challenging. In England and Wales there are legal provisions for consulting with others who know the person with impaired capacity. The role of the ‘proxy’ (or ‘surrogate’) is to advise researchers about the person’s wishes and feelings or to provide consent on the person’s behalf for a clinical trial of a medicine. Information about the study is usually provided to the proxy; however, little information is available to proxies about their role, or the appropriate legal and ethical basis for their decision, to help inform their decision-making. The aim of this study was to analyse the written information that is provided to consultees and legal representatives. Methods Studies including adults lacking capacity to consent which utilised consultees or legal representatives were identified using the UK Clinical Trials Gateway database. A representative sample ( n  = 30) were randomly selected. Information sheets and other study documents provided to proxies were obtained, and relevant content was extracted. Content analysis was conducted through four stages: decontextualisation of the unit of analysis, recontextualisation, categorisation, and compilation. The data were summarised narratively according to each theme and category. Results Considerable variation was found in the written information sheets provided to proxies. Most directed proxies to consider the wishes and feelings of the person who lacked capacity and to consult with others during the decision-making process. However, a small number of studies extended the scope of the proxy’s role to consider the person’s suitability or eligibility for the study. Particular discrepancies were found in information provided to those acting as consultees or legal representatives in a professional, as opposed to a personal, capacity. Incorrect uses of terminology were frequently found, and a small number of studies inaccurately interpreted the law. Conclusions Despite undergoing ethical review, study documents lacked essential information, incorrectly used terminology, and conflated professionals’ clinical and representation roles. Future recommendations include ensuring proxies are provided with adequate and accurate information which complies with the legal frameworks. Further research is needed to explore the information and decision-making needs of those acting as consultees and legal representatives.

Child witnesses must undergo a competence examination in which they must show appropriate conceptual understanding of lying and truth-telling, and promise to tell the truth. Three experiments (Ns = 123, 103, 177) were conducted to address the assumptions underlying the court competence examination that (1) children who understand lying and its moral implications are less likely to lie and (2) discussing the conceptual issues concerning lying and having children promising to tell the truth promotes truth-telling. Both measures of lying and understanding of truth- and lie-telling were obtained from children between 3 and 7 years of age. Most children demonstrated appropriate conceptual knowledge of lying and truth-telling and the obligation to tell the truth, but many of the same children lied to conceal their own transgression. Promising to tell the truth significantly reduced lying. Implications for legal systems are discussed.

Prison-based research has been limited due to concern that prisoners may represent a vulnerable population secondary to possible coercion and limited capacity for voluntary informed consent. This study was designed to assess decisional capacity and susceptibility to coercion in prison research subjects. Subjects were 30 mentally ill prisoners and 30 healthy controls. The groups were compared on ability to provide informed consent to a hypothetical drug trial, susceptibility to possible coercion, neuropsychological functioning, and psychiatric symptoms. Results indicated that all controls and all but one of the prisoners demonstrated adequate capacity to consent to the hypothetical drug trial. However, when decisional capacity was measured quantitatively, prisoners performed significantly worse regarding two aspects of this ability. Regarding possible coercion, prisoners’ main reasons for participating in research included avoiding boredom, meeting someone new, appearing cooperative in hopes of being treated better, and helping society. Neuropsychological functioning was strongly positively correlated with decisional capacity and negatively correlated with susceptibility to possible coercion, whereas psychiatric symptoms were only weakly correlated with these variables. In conclusion, a very high percentage of particularly vulnerable, mentally ill prisoners demonstrated adequate capacity to consent to research. Lower scores on a quantitative measure of decisional capacity suggest that extra care should be taken during the consent process when working with these subjects. The reasons prisoners gave for participating in our research indicated that the prison setting may have influenced their decision to participate, but that they were not actually coerced into doing so. Despite serious past incidents, ethicists will need to consider the possibility that prisoners have become an overprotected population.

Introduces students to the fundamental principles of mental health law and how they can be applied to everyday practice with clear introductions to key Acts such as the Mental Capacity Act and the Mental Health Act as well as the relevant Codes of Practice.

Better childhood health and nutrition, extensions to education, delays in family formation, and new technologies offer the possibility of this being the healthiest generation of adolescents ever. But these are also the ages when new and different health problems related to the onset of sexual activity, emotional control, and behaviour typically emerge. Global trends include those promoting unhealthy lifestyles and commodities, the crisis of youth unemployment, less family stability, environmental degradation, armed conflict, and mass migration, all of which pose major threats to adolescent health and wellbeing.

LEGAL ASPECTS OF MENTAL CAPACITY A Practical Guide for Health and Social Care Professionals SECOND EDITION Praise for the first edition: \"Invaluable in negotiating the legal minefield that surrounds the complicated issue of mental capacity.\" Mental Health Practice \"In Dimond's Legal Aspects of Mental Capacity, we find a well-crafted reference book that goes beyond mere presentation of the law and relevant regulations.\" Metapsychology The Mental Capacity Act (2005) regulates decision-making processes on behalf of adults who are unable to give informed consent due to a loss in mental capacity (be that from birth or due to an illness or injury at some point in their lives). Since the act's implementation, the new Court of Protection has been firmly established, and there have been significant Supreme Court cases, as well as further guidance on the 2005 Act and major developments in the use and assessment for Deprivation of Liberty Safeguards. Thoroughly updated to take into account the many updates, developments, and changes in legislation and guidance, the new edition of Dimond's authoritative guide will be warmly welcome by practitioners and students who need to understand and work within the Mental Capacity Act and how it applies to their professional responsibilities. * A highly practical guide to the Mental Capacity Act and its provisions since its conception in 2005 * Relevant for a wide range of practitioners and students within health and social care * Highly readable and easily accessible, even for those with no legal background * Includes a range of learning features, including scenarios, questions and answers, key summary points, and applications for practice. Legal Aspects of Mental Capacity is an essential resource for all healthcare and social services professionals, students, patient services managers, and carers working with those who lack the capacity to make their own decisions.

This book provides a theory-to-practice breakdown of the Mental Capacity Act 2005 and what its implications are for health and social care workers. Informative and accessible, it provides a clear depiction of the ethos behind the Act and offers instruction for its effective, lawful and person-centred application. This practical guide describes how to assess capacity and what a good assessment of capacity should look like, how to deal with conflicts and dilemmas, and the role of legal authority in decision-making. A Practical Guide to the Mental Capacity Act 2005 is an invaluable resource for any health and social care professionals working with individuals who lack decision-making capacity.

Background Decision-making capacity (DMC) is a widely used criterion in health law, but assessments pose challenges in practice. In Norway, lacking DMC became an additional criterion for involuntary care and treatment following comprehensive amendments to the Mental Health Care Act in 2017. Contrary to the amendments’ objectives, involuntary care rates have continued to increase after an initial reduction in 2017. Assessing DMC typically involves four abilities: understanding, reasoning, appreciating relevant information, and communicating a choice. This four abilities model was introduced to aid in DMC assessments. With limited assessment experience pre-2017, the Norwegian context offers valuable insights into how stakeholders integrate DMC into clinical practice over time. This study aimed to explore how DMC was assessed in clinical practice following the introduction of a capacity-based mental health law governing involuntary care and treatment in Norway. Methods In 2018, semi-structured interviews and focus groups were conducted with 44 key stakeholders, including psychiatrists, specialists in clinical psychology, general practitioners, and lawyers in supervisory bodies (the Control Commission and County Governor). In 2022–23, 21 of these participants took part in individual follow-up interviews. The interviews were transcribed and thematically analysed. Results Data analysis generated three themes with subthemes: (1) DMC assessments primarily relied on the four abilities model in specialist care, experiencing gradual clinical adaptation with decreased importance, and exhibited variations in quality, particularly in primary care; (2) several challenges in DMC assessments, including lack of training in applying the four abilities model, ownership, continuity of care, information, and patient cooperation, with certain patient groups posing particular challenges, such as those with manic symptoms, substance misuse, and severe eating disorders; and (3) quality assurance measures needed, including systematic training and tools to improve assessment quality. Conclusions Assessing DMC involves variations and several challenges across the healthcare system. While the four abilities model served as a primary basis of DMC assessments in specialist care, systematic training, validated tools, and further research seem needed to improve assessment quality and better understand factors influencing assessments. Recognising the complex interplay between legal, health service, and societal factors when implementing health law reforms seems crucial for achieving their objectives.

Background There is increasing international recognition that populations included in trials should adequately represent the population treated in clinical practice; however, adults who lack the capacity to provide informed consent are frequently excluded from trials. Addressing the under-representation of groups such as those with impaired capacity to consent is essential to develop effective interventions and provide these groups with the opportunity to benefit from evidence-based care. While the spotlight has been on ensuring only appropriate and justifiable exclusion criteria are used in trials, barriers to the inclusion of adults lacking capacity are multifactorial and complex, and addressing their under-representation will require more than merely widening eligibility criteria. This commentary draws on the literature exploring the inclusion of adults lacking the capacity to consent in research and a number of recent studies to describe the methodological, structural, and systemic factors that have been identified. Main text A number of potentially modifiable factors contributing to the under-representation of adults lacking the capacity to consent in trials have been identified. In addition to restrictive eligibility criteria, methodological issues include developing appropriate interventions and outcome measures for populations with impaired capacity. Structurally determined factors include the resource-intensive nature of these trials, the requirement for more appropriate research infrastructure, and a lack of interventions to inform and support proxy decision-makers. Systemic factors include the complexities of the legal frameworks, the challenges of ethical review processes, and paternalistic attitudes towards protecting adults with incapacity from the perceived harms of research. Conclusions Measures needed to address under-representation include greater scrutiny of exclusion criteria by those reviewing study proposals, providing education and training for personnel who design, conduct, and review research, ensuring greater consistency in the reviews undertaken by research ethics committees, and extending processes for advance planning to include prospectively appointing a proxy for research and documenting preferences about research participation. Negative societal and professional attitudes towards the inclusion of adults with impaired capacity in research should also be addressed, and the development of trials that are more person-centred should be encouraged. Further work to conceptualise under-representation in trials for such populations may also be helpful.