Applying decision-making capacity criteria in practice: A content analysis of court judgments.

Autor: Kane NB; Department of Psychological Medicine, Mental Health, Ethics and Law Research Group, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom., Keene AR; Department of Psychological Medicine, Mental Health, Ethics and Law Research Group, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom., Owen GS; Department of Psychological Medicine, Mental Health, Ethics and Law Research Group, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom., Kim SYH; Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2021 Feb 05; Vol. 16 (2), pp. e0246521. Date of Electronic Publication: 2021 Feb 05 (Print Publication: 2021).
DOI: 10.1371/journal.pone.0246521
Abstrakt: Background/objectives: Many jurisdictions use a functional model of capacity with similar legal criteria, but there is a lack of agreed understanding as to how to apply these criteria in practice. We aimed to develop a typology of capacity rationales to describe court practice in making capacity determinations and to guide professionals approaching capacity assessments.
Methods: We analysed all published cases from courts in England and Wales [Court of Protection (CoP) judgments, or Court of Appeal cases from the CoP] containing rationales for incapacity or intact capacity(n = 131). Qualitative content analysis was used to develop a typology of capacity rationales or abilities. Relationships between the typology and legal criteria for capacity [Mental Capacity Act (MCA)] and diagnoses were analysed.
Results: The typology had nine categories (reliability: kappa = 0.63): 1) to grasp information or concepts, 2) to imagine/ abstract, 3) to remember, 4) to appreciate, 5) to value/ care, 6) to think through the decision non-impulsively, 7) to reason, 8) to give coherent reasons, and 9) to express a stable preference. Rationales most frequently linked to MCA criterion 'understand' were ability to grasp information or concepts (43%) or to appreciate (42%), and to MCA criterion 'use or weigh' were abilities to appreciate (45%) or to reason (32%). Appreciation was the most frequently cited rationale across all diagnoses. Judges often used rationales without linking them specifically to any MCA criteria (42%).
Conclusions: A new typology of rationales could bridge the gap between legal criteria for decision-making capacity and phenomena encountered in practice, increase reliability and transparency of assessments, and provide targets for decision-making support.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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