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Consent is essential for legal and ethical psychological practice. EPs in the UK work with children and young people from ages 0 to 25, meaning that consent gaining practices must take account of the complexities of different professional guidelines, legislation, and case law depending on the age and competence of individual service users. This study used participatory action research to develop consent gaining guidance specific to EPs, considering issues related to children's rights, parental responsibility, Gillick competence, mental capacity, and data protection. Findings from a preliminary study were used by a stakeholder group of EPs to create draft guidance. The project was guided by a working party comprising a trainee educational psychologist, a main grade EP, a professional body representative and a solicitor specialising in education law. Implications for professional practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Background: Advance research directives (ARDs) provide a promising way to involve individuals with mild cognitive impairment (MCI) in research decisions before they lose the capacity to consent. At the same time, the views of people with MCI on ARDs are underexplored. This study assesses the perceptions of people with MCI and family members on the benefits and challenges associated with ARDs. Aims: The aim of this study was to investigate the perspectives of individuals with MCI and family members of individuals with MCI on ARDs. We focus specifically on willingness to participate in nontherapeutic research, understanding of ARDs and the ethical considerations involved. Methods: Thirteen open-ended, face-to-face interviews were conducted using a semi-structured format. Seven interviews were conducted with individuals with MCI, and six with family members of individuals with MCI. The narratives were transcribed verbatim and qualitative content analysis was carried out. Results: Research participation and ARDs were viewed positively, largely based on altruistic motives and the desire to contribute to society. The participants recognized the potential advantages of ARDs in reducing the decision-making burden on family members and maintaining personal autonomy. They also highlighted challenges in comprehending ARDs and navigating the complexities surrounding potential conflicts between current preferences versus preferences described in an ARD. Conclusions: ARDs were predominantly seen as valuable instruments that enable individuals with MCI to participate in research. This study provides insights into the reasons why affected individuals are interested in drafting ARDs. These insights can guide the development of supportive interventions that are tailored to assist individuals with MCI and their families in navigating ARD processes. [ABSTRACT FROM AUTHOR]

SUMMARY: To make a valid will, a person should be able to understand the nature and consequences of doing so, the extent of their estate and the claims others may have on it. No disorder of mind should be present that would affect their testamentary decisions, and clinicians are therefore often asked to give an opinion on whether a person has testamentary capacity. This article discusses the legal issues involved, with reference to UK case law (in particular, the legal test of Banks v Goodfellow (1870)), and outlines the requirements of testamentary capacity assessment (including retrospective assessments), the clinician's responsibilities when requested by a solicitor to make an assessment of capacity ('the golden rule') and what they might expect if appearing in court to give expert witness regarding testamentary capacity. Fictitious case studies are presented illustrating certain points in testamentary capacity assessment. [ABSTRACT FROM AUTHOR]

Seeking an anticipatory declaration from the Court of Protection (CoP) to manage a risk of future loss of capacity in pregnant people during labour and delivery appears to be occurring more frequently. This article examines a growing case sample of recent CoP judgments in which anticipatory declarations have been sought and adopts a combined relational and spatial approach to question whether these types of anticipatory declarations empower patient autonomous choice, and to illuminate the complex web of relational, spatial, and temporal factors that hold influence over the way in which mental capacity law operates. Viewing such processes from both a patient and institutional perspective offers useful insights into the law's normative workings, boundaries, and constraints, and ultimately points to conclusions on the (in)effectiveness of anticipatory declarations as a legal mechanism for dealing with the risk of a patient losing capacity in the future. Moreover, however, taking a broader, spatial view signals the challenges posed by these cases to mental capacity legislation itself. The justifiability of the binary construct of capacity/incapacity has been challenged by some writers in this field, and this article offers further reflection on the integrity of this binary through its discussion of anticipatory orders for pregnant people. [ABSTRACT FROM AUTHOR]

In an ageing world with a growing prevalence of neurodegenerative disease and recent voluntary assisted dying laws in New Zealand and several Australian states, healthcare professionals are increasingly being relied upon to conduct decision-making capacity (DMC) assessments. There is no legislation in New Zealand or Australia to provide clear guidance on conducting DMC assessments. This systematised review aimed to examine the current processes, issues and debates within DMC assessments as detailed in Australasian literature. Six databases were searched: CINAHL, Scopus, Embase, Medline, PsycINFO and Google Scholar following PRISMA guidelines. A total of 33 articles were included in the review and, following a quality assessment, an inductive approach was used to determine key topics which were synthesised in the review. Five distinct issues were revealed, namely a lack of standardisation and guidelines in approaching DMC assessments, training and knowledge of DMC, professional roles, medical and psychiatric complexities and the medico-legal interface. [ABSTRACT FROM AUTHOR]

AbstractInmates’ food refusal is a large-scale phenomenon raising clinical, ethical, and professional responsibility issues. Obtaining a clinical balance of the right to refuse food with the right to protect the inmate’s health can be a challenging process. Several reasons may support inmates’ choice of refusing food, including political or protest reasons, as well as psychiatric disorders. The World Medical Association defines a hunger striker as a mentally competent person who has indicated his/her decision to go on a hunger strike by refusing to take any food and/or liquid for a significant amount of time. Force-feeding of mentally capable people is not allowed by a legal standpoint, nor medical treatment can be carried out without patients’ explicit consent. According to these premises, both the clinical assessment of possible concurrent psychiatric disorders as well as the assessment of inmates’ mental capacity to make decisions about refusing food might help in understanding this behavioural issue. We will also discuss the ethical and legal implications related to the right of refusing food according to the current Italian legislation. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that being able to die well with dementia is of equal importance to living well with dementia • To consider why there may be a low uptake of advance care planning (ACP) in people with dementia • To learn about when to initiate an ACP discussion with a person with dementia. Recent policy focus in dementia care has been on living well with the condition; however, being able to die well with dementia is of equal importance. Advance care planning (ACP) enables people to consider, express and record their wishes and preferences for palliative and end of life care, however there is a low uptake of ACP in people with dementia. Although ACP discussions should be initiated as soon as possible after a diagnosis of dementia, there are other opportunities and transition points in the person’s care during which health and social care professionals could promote, engage in and support ACP discussions. This article considers the importance of ACP in dementia care and uses a case study to explore opportunities for initiating and engaging in ACP with people with dementia. [ABSTRACT FROM AUTHOR]

Background: Dementia is assumed to alter mental capacity, which may necessitate legal guardianship. However, only limited research exists on how dementia affects mental capacity, and most studies have focused solely on a medical perspective and concentrate on memory functions. The aim of this qualitative study was to investigate physicians' and legal experts' perceptions on a broad range of cognitive and neuropsychiatric domains potentially affecting mental capacity and the need for guardianship in people with dementia. Methods: Physicians (N = 30) and legal experts (N = 20) participated in semi‐structured individual interviews. The data were analyzed by using content analysis and further semi‐quantified according to the cognitive and neuropsychiatric domains. Results: Physicians considered neuropsychiatric symptoms and executive dysfunction to be the most important deficits in the legal context, while legal experts highlighted episodic memory impairment and dyscalculia. Perceptions regarding the importance of several cognitive and neuropsychiatric symptoms varied between and within the professional groups. Conclusions: Physicians and legal experts diverged in their perceptions of cognitive and neuropsychiatric domains affecting mental capacity and the need for guardianship. The evaluation and influence of medical evidence among legal experts heavily rely on subjective opinions. Given the substantial potential impact on patients' equal access to their rights, developing standardized guidelines is essential. [ABSTRACT FROM AUTHOR]

This article analyses the use of mediation to resolve mental capacity law disputes, including those that arise in the healthcare context. It draws on original empirical data, including interviews with lawyers and mediators, and analysis of a mediation scheme, to argue that mediation has the potential to be an effective method of resolution in mental capacity law. It highlights the relationship benefits of mediation while acknowledging the challenges of securing P's participation and best interests. The final section of the article considers how mediation can operate in one of the most challenging healthcare environments, the Intensive Care Unit. The article emphasizes that the challenges we see in mediation are not unique and exist across the spectrum of Court of Protection practice. Therefore, the article concludes that mediation may be used effectively but the jurisdiction would also benefit from a clearer regulatory framework in which it can operate. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the motor, kinetotherapeutic, and psychological benefits of three aquatic therapeutic programs—aquagym recovery (AG), aquatic ludotherapy (ALT), and therapeutic swimming (TS)—for students specializing in balneo-physio-kinetotherapy. Methods: The study group consisted of 101 students, out of which 43 students from the balneo-physiokinetotherapy study program (BFKT) and 67 master's degree students from physical therapy and functional rehabilitation (PTFR). The questionnaire was named Questionnaire regarding the benefits of therapeutic aquatic programs (QBTAP), and included 3 subscales according to the typology of the targeted objectives, namely: motor, kinetotherapeutic and psychological. The items of each subscale correspond to the objectives identified in the content of the 3 aquatic programs stipulated in the content of the courses corresponding to the disciplines in the education plans of academic study programs (BFK, TRFR). The motor subscale included 8 items, the kinetotherapeutic subscale included 16 items, and the psychological subscale included 10 items. The evaluation of the QBTAP questionnaire 5-point Likert scale. The three evaluated programs were: recovery aquagym (AG), aquatic ludotherapy (ALT) and therapeutic swimming (TS). Results: The results and conclusion sections should highlight the main findings succinctly. For example: ''The QBTAP showed high internal consistency (Cronbach's Alpha >0.9) across all subscales and programs, with significant differences identified between the three programs (p

Why you should read this article: • To better understand the areas of risk that may become apparent across the life course of dementia • To recognise the ethical issues posed by trying to eliminate the risk of harm for people living with dementia • To consider how the principles of safeguarding apply to risk management in dementia care. What constitutes a risk for a person living with dementia may be perceived and prioritised differently by nurses from varying clinical backgrounds. Furthermore, risk may be perceived differently according to the context. This article outlines some of the social, psychological and physical risk factors relevant to people living with dementia across the life course of the condition. It is important that nurses understand their role in identifying, assessing and managing risk and are aware of the resources, policies, legislation and processes designed to support decision-making and minimise the risk of harm to people living with dementia, their families and carers. The authors hope that this article will support nurses to become more confident in identifying risk while encouraging them to adopt a proactive and person-centred approach to risk assessment and management. [ABSTRACT FROM AUTHOR]

Educational psychologists (EPs) have a legal and ethical obligation to gain informed consent prior to any psychological involvement. As EPs work across the 0 to 25 age range, the person giving consent may vary according to the needs of the individual service user and so it is necessary to be aware of relevant legislation and case law. This study explored what might be considered best practice for EPs in gaining consent across the 0 to 25 age range by conducting semi-structured interviews with six professionals as part of an expert reference group. The interviews were thematically analysed using a hybrid inductive-deductive approach. Six main themes were identified: ethical obligations; children's rights; legal obligations; partnership; informed consent; and, barriers to best practice. There was considerable overlap between some of the main themes, reflecting the complexity of the issue. The findings are discussed in relation to literature in other areas of psychological practice. Implications for practice for individual EPs and EP services are considered, such as the possibility of developing a guidance document for use across the profession, as well as directions for further research. [ABSTRACT FROM AUTHOR]

Background and Objectives Paradoxical lucidity is defined as an instance of unexpected lucid behavior in a person who is assumed to be noncommunicative due to a progressive and pathophysiologic dementing process. To inform studies of the prevalence, characteristics, and impact of these behaviors, this interview study examined caregivers' experiences of witnessing paradoxical lucidity. Research Design and Methods Participants were family caregivers of persons living with advanced dementia caused by a neurodegenerative disease producing significant impairments in communication. Semistructured interviews elicited the caregivers' experiences of plausible lucid episodes. Data analysis used a thematic analysis approach. Results Most caregivers reported at least 1 episode of lucidity. Episodes were typically brief. Most involved utterances, but nonverbal behaviors were also common. The mental capacities associated with these behaviors included recognition, awareness of surroundings, recognizing others' emotions, and goal-directed behavior. Most caregivers' reactions were positive. Episodes did not lead to changes in major medical decisions but instead to efforts to either modify or reinforce daily caregiving efforts. Discussion and Implications Episodes of lucidity were common, a finding seen in other studies. If prevalence studies confirm this, the qualifier "paradoxical" should be eliminated. The caregivers' familiarity with the person living with dementia allowed them to attribute meaning to subtle behaviors that might not otherwise be detected or considered lucid. Clinicians who care for persons with advanced-stage dementia should routinely ask caregivers about episodes of lucid communication and their emotional reactions. [ABSTRACT FROM AUTHOR]

Background and objectives People with parkinsonism who are older, living in a care home, with frailty, multimorbidity or impaired capacity to consent are under-represented in research, limiting its generalisability. We aimed to evaluate more inclusive recruitment strategies. Methods From one UK centre, we invited people with parkinsonism to participate in a cross-sectional study. Postal invitations were followed by telephone reminders and additional support to facilitate participation. Personal consultees provided information on the views regarding research participation of adults with impaired capacity. These approaches were evaluated: (i) using external data from the Parkinson's Real World Impact assesSMent (PRISM) study and Clinical Practice Research Datalink (CPRD), a sample of all cases in UK primary care, and (ii) comparing those recruited with or without intensive engagement. Results We approached 1,032 eligible patients, of whom 542 (53%) consented and 477 (46%) returned questionnaires. The gender ratio in PRIME-UK (65% male) closely matched CPRD (61% male), unlike in the PRISM sample (46%). Mean age of PRIME participants was 75.9 (SD 8.5) years, compared to 75.3 (9.5) and 65.4 (8.9) years for CPRD and PRISM, respectively. More intensive engagement enhanced recruitment of women (13.3%; 95% CI 3.8, 22.9%; P  = 0.005), care home residents (6.2%; 1.1, 11.2%; P  = 0.004), patients diagnosed with atypical parkinsonism (13.7%; 5.4, 19.9%; P  < 0.001), and those with a higher frailty score (mean score 0.2, 0.1, 0.2; P  < 0.001). Conclusions These recruitment strategies resulted in a less biased and more representative sample, with greater inclusion of older people with more complex parkinsonism. [ABSTRACT FROM AUTHOR]

This reflective account discusses a case where a patient refused a safeguarding referral after disclosing domestic abuse to a student paramedic on an MSc programme. The author examines the medical, ethical and legal evidence when determining whether the right path was taken in caring for this patient. It is argued that the care delivered was lawful and ethical but the student paramedic did not have sufficient awareness of the support options available to those experiencing domestic abuse. Their oversimplification of the dilemma to the patient having capacity to refuse referral omitted key aspects of the medico-legal framework, potentially to the detriment of the patient's care. Reflective learning has allowed the author to recognise the limits of his understanding of the complex medico-ethico-legal framework surrounding domestic abuse, consent, coercion and controlling behaviour. In response, he has established a new methodology to assess the underlying reasons for refusing a safeguarding referral. [ABSTRACT FROM AUTHOR]

Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To read about the steps involved in a project that aimed to increase cervical screening uptake among people with learning disabilities • To recognise barriers to accessing cervical screening among people with learning disabilities • To increase your awareness of the legal requirement for assessing mental capacity in people with learning disabilities in the context of cervical screening. The uptake of cervical screening is lower among people with learning disabilities than in the general population. Between 2020 and 2022, a pilot project was undertaken in south west Hertfordshire to increase the uptake of cervical screening among people with a cervix who are eligible for screening and registered with their GP as having a learning disability. The project included the development of an ad hoc reporting and decision-making tool and involved a community learning disability nurse working with ten GP practices to take patients through a preparatory process designed to assess their mental capacity and determine their reasonable adjustment needs. The number of patients who had cervical screening within the project time frame was small, but there were other positive outcomes for the patients and practice nurses involved, particularly in relation to clarifying the benefits of cervical screening and the rules about mental capacity and best interests decisions. [ABSTRACT FROM AUTHOR]

Introduction: The competence assessment to give informed consent in the legal and healthcare settings is often performed merely through clinical judgment. Given the acknowledged limited reliability of clinician-based evaluation in the mental health sector, particularly for the assessment of competence to consent, our objective was to ascertain the dependability of clinical judgment when evaluating the ability of schizophrenia patients to make choices about their health. Methods: The potential convergence between clinical evaluation and scores from a new standardized assessment (the "Evaluation of Informed Consent to Treatment" - "EICT" scale) was therefore tested. The scale assesses four dimensions of competence, specifically how patients normally understand information relating to care (Understanding); how they evaluate the choice of treatment in terms of risk/benefit ratio (Evaluating); how they reason coherently in the decision-making process (Reasoning); and, finally, their ability to make a choice between treatment alternatives (Expressing a choice). Thirty-four outpatients with schizophrenia were evaluated for their competence to consent by five referring clinicians with different backgrounds (psychiatrist, forensic psychiatrist, geriatrician, anesthetist, and medico-legal doctor). Inter-raters variability was tested through correlation analyses between the scores obtained by the clinicians on a modified version of the Global Assessment of Functioning scale (GAF) designed specifically to subjectively assess functioning in each of the four competence dimensions. Two validated competence scales (Mac- CAT-T, SICIATRI-R), and a neuropsychological battery were also administered along with scales for evaluating neuropsychiatric symptoms severity and side effects of medication. Results: Clinical judgments of the individual specialists showed great inter-rater variability. Likewise, only weak/non-significant correlations were found between the EICT subscales and the respective clinicians-rated GAF scales. Conversely, solid correlations were found between the EICT and MacCAT-T subscales. As expected, healthy controls performed better in the ability to give informed consent to treatment, as measured by the three scales (i.e., EICT, MacCAT-T, and SICIATRI-R), and neuropsychological test performance. In the comparisons between patients who, according to the administered EICT, were able or not able to give informed consent to treatment, significant differences emerged for the Phonemic verbal fluency task (p = 0.038), Verbal judgments (p = 0.048), MacCAT-T subscales, and SICIATRI-R total score. Moreover, EICT exhibited excellent internal consistency (Cronbach's alphas ranging from 0.96 to 0.98 for the four subscales) while the Item Analysis, by measuring the correlation between each item of the EICT and the total score, was excellent for all items of all subscales (alphas ranging from 0.86 to 0.98). Discussion: In conclusion, our findings highlighted that the assessment of competence exclusively through clinical judgment is not fully reliable and needs the support of standardized tools. The EICT scale could therefore be useful in assessing general competence to consent both in healthcare and legal contexts, where it might be necessary to evaluate the effective competence of patients with psychiatric disorders. Finally, this scale could serve as a valuable tool for decisions regarding whether and to what extent a patient needs support. [ABSTRACT FROM AUTHOR]

BackgroundAdvance research directives (ARDs) provide a promising way to involve individuals with mild cognitive impairment (MCI) in research decisions before they lose the capacity to consent. At the same time, the views of people with MCI on ARDs are underexplored. This study assesses the perceptions of people with MCI and family members on the benefits and challenges associated with ARDs.AimsThe aim of this study was to investigate the perspectives of individuals with MCI and family members of individuals with MCI on ARDs. We focus specifically on willingness to participate in nontherapeutic research, understanding of ARDs and the ethical considerations involved.MethodsThirteen open-ended, face-to-face interviews were conducted using a semi-structured format. Seven interviews were conducted with individuals with MCI, and six with family members of individuals with MCI. The narratives were transcribed verbatim and qualitative content analysis was carried out.ResultsResearch participation and ARDs were viewed positively, largely based on altruistic motives and the desire to contribute to society. The participants recognized the potential advantages of ARDs in reducing the decision-making burden on family members and maintaining personal autonomy. They also highlighted challenges in comprehending ARDs and navigating the complexities surrounding potential conflicts between current preferences versus preferences described in an ARD.ConclusionsARDs were predominantly seen as valuable instruments that enable individuals with MCI to participate in research. This study provides insights into the reasons why affected individuals are interested in drafting ARDs. These insights can guide the development of supportive interventions that are tailored to assist individuals with MCI and their families in navigating ARD processes.

Some care home residents with dementia have the capacity, some do not. Staff may need to make decisions about administering care interventions to someone whom they believe lacks the capacity to consent to it, but also resists the intervention. Such intervention can be termed forced care. The literature on forced care (especially reflecting empirical work) is scant. This study aims to investigate how the ethics of forced care is navigated in practice, through ten semi-structured interviews with staff in 1 care home in the North East of England. Participants generally avoided situations where there was overt restraint, taking a flexible approach by either modifying their own behaviour or using covert techniques. The underlying justification given for decisions or actions tended to be that the recipients of care should be valued because of their intrinsic worth as fellow human beings. Participants attempted to put themselves in the position of the resident or think about what a beloved elderly relative would want. The intervention seemed acceptable to staff if the resident was not distressed. When staff were presented with scenario-based questions around capacity they were more successful than when asked direct questions relating to the Mental Capacity Act. Scenario-based training may be helpful to reinforce familiarity and facility with the principles of the Mental Capacity Act. [ABSTRACT FROM AUTHOR]

AbstractEating disorders represent a disabling, deadly and costly condition, whose principal treatment is constituted by weigh restoration and psychotherapy. Partial or total refuse of treatment is very common, leading some authors to question their decision-making capacity (DMC) to consent to treatment. However, very few studies have investigated treatment DMC, leading to contrasting results. Forty-five women were enrolled at the Psychiatric and Eating Disorders Unit of the University Hospital Policlinico Umberto I of Rome. Psychiatric symptoms severity (Brief Psychiatric Rating Scale Expanded, BPRS-E), treatment DMC (MacArthur Competence Assessment Tool for Treatment, MacCAT-T), depressive symptoms (Hamilton Depression Rating Scale, HAM-D), anxiety symptoms (Hamilton Anxiety Rating Scale, HAM-A), symptoms and psychological characteristics of eating disorders (Eating Disorder Inventory, EDI-3) and Metacognitive beliefs (Metacognitions Questionnaire 30, MCQ-30) were assessed. Sixty-seven percent of the total sample showed low treatment DMC; specifically, 70.4% of patients affected by Anorexia Nervosa, 72.7% of patients affected by Bulimia Nervosa, and 42.9% of patients affected by Binge Eating Disorder. Specific psychopathological symptoms enhance or hamper patients’ decisional capacities. Clinicians should be aware of the risk of impaired DMC in this vulnerable group of patients and pay attention at those factors suggesting the need of an in-depth evaluation. [ABSTRACT FROM AUTHOR]

Background The Mental Capacity Act 2005 of England and Wales is a ground-breaking piece of legislation with reach into healthcare, social care and legal settings. Professionals have needed to develop skills to assess mental capacity and handle malign influence, but it is unclear how assessments are implemented in real world settings. Our previously reported survey found professionals juggling competing resources in complex systems, often struggling to stay up to date with law. The current follow-up study uses one-to-one interviews of professionals to characterise in detail six areas of uncertainty faced when assessing mental capacity, whilst suggesting ways to make improvements. Methods Forty-four healthcare, social care and legal professionals were interviewed, using a semi-structured topic guide. Transcripts were analysed using framework analysis: a qualitative technique built to investigate healthcare policy. Results Our topic guide generated 21 themes. In relation to the six areas of uncertainty: 1) Many participants stressed the importance of capturing a holistic view, adding that their own profession was best-placed for this - although a medical diagnosis was often needed. 2) The presumption of capacity was a laudable aim, though not always easy to operationalise and occasionally being open to abuse. 3) There was cautious interest in psychometric testing, providing a cognitive context for decisions. 4) Undue influence was infrequent, but remained under-emphasised in training. 5) Multi-professional assessments were common, despite doubts about fitting these within local resources and the law. 6) Remote assessment was generally acceptable, if inadequate for identifying coercion. Conclusions Practical constraints and competing demands were reported by professionals working within real world systems. Assessment processes must be versatile, equally applicable in routine and emergency settings, across diverse decisional types, for both generalist and specialist assessors, and able to handle coercion. Recognising these challenges will guide development of best practices in assessment and associated policy.

In this month's Policy column, Iwan Dowie discusses the 'deprivation of liberty' − which is used to safeguard patients who may be lacking sufficient mental capacity to manage their own safety. The author, through previous legal cases, shares how the Deprivation of Liberty Safeguards (DoLS)—an amendment to the Mental Capacity Act 2005—came into being, and the importance of community nurses in knowing the DoLS. [ABSTRACT FROM AUTHOR]

IntroductionThe competence assessment to give informed consent in the legal and healthcare settings is often performed merely through clinical judgment. Given the acknowledged limited reliability of clinician-based evaluation in the mental health sector, particularly for the assessment of competence to consent, our objective was to ascertain the dependability of clinical judgment when evaluating the ability of schizophrenia patients to make choices about their health.MethodsThe potential convergence between clinical evaluation and scores from a new standardized assessment (the “Evaluation of Informed Consent to Treatment” - “EICT” scale) was therefore tested. The scale assesses four dimensions of competence, specifically how patients normally understand information relating to care (Understanding); how they evaluate the choice of treatment in terms of risk/benefit ratio (Evaluating); how they reason coherently in the decision-making process (Reasoning); and, finally, their ability to make a choice between treatment alternatives (Expressing a choice). Thirty-four outpatients with schizophrenia were evaluated for their competence to consent by five referring clinicians with different backgrounds (psychiatrist, forensic psychiatrist, geriatrician, anesthetist, and medico-legal doctor). Inter-raters variability was tested through correlation analyses between the scores obtained by the clinicians on a modified version of the Global Assessment of Functioning scale (GAF) designed specifically to subjectively assess functioning in each of the four competence dimensions. Two validated competence scales (Mac-CAT-T, SICIATRI-R), and a neuropsychological battery were also administered along with scales for evaluating neuropsychiatric symptoms severity and side effects of medication.ResultsClinical judgments of the individual specialists showed great inter-rater variability. Likewise, only weak/non-significant correlations were found between the EICT subscales and the respective clinicians-rated GAF scales. Conversely, solid correlations were found between the EICT and MacCAT-T subscales. As expected, healthy controls performed better in the ability to give informed consent to treatment, as measured by the three scales (i.e., EICT, MacCAT-T, and SICIATRI-R), and neuropsychological test performance. In the comparisons between patients who, according to the administered EICT, were able or not able to give informed consent to treatment, significant differences emerged for the Phonemic verbal fluency task (p = 0.038), Verbal judgments (p = 0.048), MacCAT-T subscales, and SICIATRI-R total score. Moreover, EICT exhibited excellent internal consistency (Cronbach’s alphas ranging from 0.96 to 0.98 for the four subscales) while the Item Analysis, by measuring the correlation between each item of the EICT and the total score, was excellent for all items of all subscales (alphas ranging from 0.86 to 0.98).DiscussionIn conclusion, our findings highlighted that the assessment of competence exclusively through clinical judgment is not fully reliable and needs the support of standardized tools. The EICT scale could therefore be useful in assessing general competence to consent both in healthcare and legal contexts, where it might be necessary to evaluate the effective competence of patients with psychiatric disorders. Finally, this scale could serve as a valuable tool for decisions regarding whether and to what extent a patient needs support.

Objective: Decision-making capacity for treatment is impaired in schizophrenia but it remains unknown if schizophrenia affects distinct decision-making capacities differently. Methods: In this study, we assessed concomitantly two decision-making capacities (i.e., antipsychotic treatment and COVID-19 vaccination) in 27 schizophrenia patients. Sociodemographic variables, psychotic symptoms, global cognition and insight were also assessed. Results: We found that among individuals incompetent to consent to antipsychotic treatment, one-third had preserved capacity to consent to vaccination. No significant associations between the two different decision-making capacities were found. Psychotic symptoms and cognition were associated with the capacity to consent to antipsychotic treatment and to vaccination, respectively. Conclusion: Clinicians should be aware that capacity to consent to treatment is not unidimensional and vary across domains in individuals with schizophrenia. Being incompetent regarding one treatment does not mean to be incompetent for another treatment in this clinical population. [ABSTRACT FROM AUTHOR]

In 2014, the United Nations Convention on the Rights of Disabilities adopted recommendations advising the replacement of involuntary care with supported care. This has polarised many about how best to provide for People living with Mental Conditions (PLPCs). Notwithstanding the contentions of this debate, we find on a personal discursive level that involuntary care is concealed as a self-evident and unquestionable response to the treatment of PLPCs. This can mean that policy-makers and professionals reproduce approaches to PLPCs uncritically. Considering these complexities, we used Critical Discourse Analysis (CDA) to examine what current norms surround involuntary care in the South African psy-complex, and how these are reproduced. We interviewed nine members of the South African psy-complex, including review board members, psychologists, and psychiatrists, and found several discourses maintaining current psychiatric norms. These include biomedical and techno-disciplinary discourses of treatment, clinico-legal disciplinary and danger discourses, and paternalistic discourses of institutional care. Each of these uniquely highlights the ways in which involuntary care is maintained and normalised, revealing that careful consideration is required to prevent potential human rights violations on behalf of professionals and policy-makers, regardless of whether in involuntary or support paradigms. [ABSTRACT FROM AUTHOR]

The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as "procedural ethics" and the identification and handling of ethical issues by researchers during the research process as "ethics in practice." While some authors dispute and other authors defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice. This article aims to provide an illustration of research ethics in practice by reflecting on the ways in which we identified and addressed ethical and methodological issues that arose in the context of an interview study with mental health service users and relatives. We describe the challenges we faced and the solutions we found in relation to the potential vulnerability of research participants, the voluntariness of consent, the increase of participant access and the heterogeneity of the sample, the protection of privacy and internal confidentiality, and the consideration of personal and contextual factors. [ABSTRACT FROM AUTHOR]

The current research aimed to reveal the relationship between mental capacity and academic self-efficacy among students of the Faculty of Education, Beni Suef University, on a sample of (400) male and female students, with an average age (19.71) and a standard deviation (3.10), and the mental capacity scale was applied, "prepared by the researcher And the scale of academic self-efficacy "prepared by Shaima Ibrahim, 2021" in the second semester of the academic year 2022-2023 AD, and the descriptive correlational approach was used, and the results showed that there is a statistically significant positive correlation relationship at the level (0.01) between mental capacity and academic self-efficacy among individuals The research sample. [ABSTRACT FROM AUTHOR]

As individuals grow older, a gradual decline in physiological function, psychosocial interaction, and financial resources can limit their ability to live independently. This qualitative descriptive study explored the perspectives of 32 older adults aged 60 years or older with no physical disability residing in Metro Manila and Central Luzon Island in the Philippines. The data were collected through in-depth interviews using a semi-structured interview guide from April to December 2019, and data were analyzed using content analysis. The findings revealed that Filipino older adults' perspectives of independent living encompass a range of factors: 1) Ensuring physical health, with two subcategories (maintaining good health and ability to engage in self-care); 2) Maintaining mental capacity, with three subcategories (unburdening others, gaining control over their lives, and being able to make decisions; 3) Maintaining social relationships with others, with two subcategories (forming meaningful connections, and maintaining positive relationships with others; 4) Being financially stable by having a stable source of income; and 5) Being spiritually connected by maintaining religious practices. Independent living is a multidimensional concept that reflects Filipino older adults' physical, psychosocial, economic, and spiritual needs. By understanding and utilizing these findings, nurses can develop targeted interventions to help older people meet their needs and remain independent as possible. Furthermore, policymakers can use the findings to make informed decisions in healthcare planning to promote independent living and healthy aging in the Philippines. [ABSTRACT FROM AUTHOR]

Objectives The aim of the article is to describe the Council of Europe's standard on medical (health care) proxy, which is granted in the event of decision-making incapacity. Examination of the legal norms, jurisprudence and values preferred by the Council of Europe will provide an opportunity to compare the Polish legal system with the standard of the Council of Europe, anticipating potential directions of the de lege ferenda solutions. Material and methods The paper uses the formal-dogmatic method. The analysis was based on: European Convention on Human Rights, European Convention on Bioethics, soft law documents, judicial decisions and literature findings. Results The results of the conducted research embrace the specific guidelines derived from the Council of Europe's standard for maintaining the autonomy of decision-making incapable individuals. The institution of health care proxy (medical power of attorney), when properly shaped, meets the requirements described. Conclusions The Council of Europe standard is in favour of diversifying the model of decision-making for an adult lacking capacity. The member states should make efforts to create the possibility for the person anticipating lack of capacity to choose the decision-maker on his or her behalf. A strong emphasis is also placed on preventing decision-making exclusion by creating participating mechanisms, as well as respecting the previously expressed wishes and preferences of the incapable person. The health proxy is an instrument that allows the preferences of the Council of Europe to be fulfilled, both in the context of making declarations in the event of incapacity and allowing the incapable person to be involved. A properly shaped regulation of this legal relationship ensures that the autonomy of the individual is respected and extended.

ObjectiveDecision-making capacity for treatment is impaired in schizophrenia but it remains unknown if schizophrenia affects distinct decision-making capacities differently.MethodsIn this study, we assessed concomitantly two decision-making capacities (i.e., antipsychotic treatment and COVID-19 vaccination) in 27 schizophrenia patients. Sociodemographic variables, psychotic symptoms, global cognition and insight were also assessed.ResultsWe found that among individuals incompetent to consent to antipsychotic treatment, one-third had preserved capacity to consent to vaccination. No significant associations between the two different decision-making capacities were found. Psychotic symptoms and cognition were associated with the capacity to consent to antipsychotic treatment and to vaccination, respectively.ConclusionClinicians should be aware that capacity to consent to treatment is not unidimensional and vary across domains in individuals with schizophrenia. Being incompetent regarding one treatment does not mean to be incompetent for another treatment in this clinical population.

Shared decision-making is a fundamental aspect of person-centered care, and can and should be part of many different aspects of the rehabilitation process. Communication disabilities like aphasia, which affects people's ability to use and understand spoken and written language, can make shared decision-making especially challenging to the resources and skills of rehabilitation practitioners. The purpose of this narrative review is to provide a comprehensive description of tools that can support successful shared decision-making with people with aphasia in the rehabilitation environment. These tools and strategies are appropriate for use by physicians, nurses, social workers, physical therapists (also referred to as physiotherapists), occupational therapists, and other service or care providers. The important role of speech-language pathologists as consultants is also described. Case scenarios throughout the paper illustrate the application of recommended tools and strategies along with best practices.

Background Hospital clinicians find mental capacity assessment challenging and may lack the necessary skills. Given high rates of cognitive impairment, data on mental capacity assessment in real-world hospital cohorts are required to inform the need for staff training and workforce planning. Objectives In unselected medical inpatients, we determined the rate and outcome of mental capacity assessment by decision type and underlying brain/mind disorder, and recorded the discipline of the assessor. Methods We included consecutive patients (October–November 2018; November–December 2019) admitted to the complex medicine unit providing acute multidisciplinary care for multi-morbid patients (age ≥ 16 years, average age > 80 years). Audit data were collected at ward multidisciplinary meetings and extracted from electronic patient records. Results Among 892 patients (mean/SD age = 82.8/8.6, 465 male), 140 (16%) required mental capacity assessment (40/140 (29%) had ≥2 assessments) with 203 assessments in total of which 162 (80%) were done by doctors. Capacity was deemed lacking in 124 (61%) assessments, most commonly in delirium with/without other co-morbid conditions (94/114, 82%) or dementia (9/12, 75%) with lower rates in other disorders (15/27, 56%), and no formal diagnosis of brain/mind disorder (6/50, 12%). Cognitive test scores were overall lower in those lacking capacity (mean/SD abbreviated-mental-test-score = 5.2/2.6, range = 0–10 versus 6.8/2.8, P  = 0.001, range = 1–10). Decisions involving discharge planning were most often assessed (48%) followed by treatment (29%), discharge against medical advice (12%) and others (11%). Conclusion Mental capacity assessments were performed frequently and often repeated, justifying the need for robust training in the practical application of the principles of capacity assessment for staff managing complex older patients. [ABSTRACT FROM AUTHOR]

This case note considers the role of section 48 orders under the Mental Capacity Act 2005 following the decision by Mostyn J in A Local Authority v LD and RD [2023] EWHC 1258 (Fam). The case concerned an application for removal from home for a man in his 40s with learning disability, autism and Down's Syndrome for the purposes of assessment of mental capacity. The case note considers the role and function of interim orders under section 48 as well as the wider problem of removing adults from their own home in the name of safeguarding. [ABSTRACT FROM AUTHOR]

The UK Space Industry Act 2018 has now been supplemented with the new Space Industry Regulations. While examples of Space Tourism grace our screens and newsfeeds on an increasingly regular basis such as William Shatner's recent voyage (Luscombe, 2021) the UK Regulations also pave the way for 'human occupants' (UK Space Industry Regulations, Regulation 2) to experience such a flight (UK Space Agency, 2020). A key part of the regulations pertaining to human occupants is that they must provide 'informed consent' before embarking on such a flight. If, as is likely to be the case, future courts are to draw analogies with the current state of medical law in this area, spaceflight operators will have to tread carefully if they are to avoid vitiating any informed consent by 'bombarding' any willing human occupant with technical detail prior to their flight (Simmonds, 2020). Whilst this could prove legally problematic for 'capacitous' individuals within the meaning of the Mental Capacity Act 2005, it is likely to be even more so for those who could be deemed, in some aspects of their cognitive ability, to lack capacity. UK Space Legislation as it presently stands faces three problems: 1) There is presently no legal mechanism under UK Space Law to determine capacity. 2) As examples from the Court of Protection indicate, 'capacity' is a very nuanced legal concept and individuals who, on the fact of things, may appear to lack capacity as regards potentially risky activities, have been regarded by the Courts as, at least, partially capacitous in respect of certain decisions. Operators may find themselves having to tread a fine line to avoid claims of discrimination. 3) because of point 1) and the state of the Law of Contract as regards contractual relationships entered into by potentially incapacitous individuals, further significant legal problems may present themselves. This paper will focus primarily on the Law in England and Wales but some of the overarching conclusions will be of relevance to all UK jurisdictions. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the ethical issues associated with administering antipsychotic medicines to people with dementia • To learn about the main elements of various ethical frameworks and theories commonly used in nursing • To enhance your understanding of how you could apply ethical frameworks to your practice Antipsychotic medicines are often prescribed 'as required' to manage behavioural and psychological symptoms of dementia, despite evidence that these medicines have little benefit for people with dementia and have numerous adverse side effects, including sedation. It is the nurse's role to decide if and when to administer antipsychotic medicines that have been prescribed on an as required basis. This decision-making is underpinned by complex ethical considerations such as mental capacity, chemical restraint, quality of life and autonomy. Adopting a person-centred approach and considering the ethics, guidelines and legislation related to such decisions can support nurses to act in patients' best interests. This article uses two ethical frameworks – the four principles of biomedical ethics and the 'four quadrants' approach – to examine this complex issue and to demonstrate their use in the context of ethical decision-making in nursing practice. [ABSTRACT FROM AUTHOR]

Should the assessment of decision‐making capacity (DMC) be risk sensitive, that is, should the threshold for DMC vary with risk? The debate over this question is now nearly five decades old. To many, the idea that DMC assessments should be risk sensitive is intuitive and commonsense. To others, the idea is paternalistic or incoherent, or both; they argue that the riskiness of a given decision should increase the epistemic scrutiny in the evaluation of DMC, not increase the threshold for DMC. We respond to the critics' main concerns by providing a comprehensive account of how risk‐sensitive DMC is coherent, avoids paternalism, and best fulfills the epistemic goal of DMC evaluations. [ABSTRACT FROM AUTHOR]