Decision-making capacity in clinical and research settings

Clinical Center

Investigators

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Abstract

1. We completed our analysis of how the courts (judges and expert consultants to the court) interpreted the decision making criteria in the Mental Capacity Act. We analyzed 131 Court of Protection cases and created a typology of capacity rationales that appeared to underlie the judgments of the judges/experts. This typology has 9 rationales (with two having subcategories, so that total categories = 13). We further found associations between these rationales with the MCA criteria and the various disorders that form the basis for incapacity. This paper was published in PLOS ONE (see biblio). 2. A follow up 'critical normative analysis'was subsequently undertaken to outline how to optimize the application of the DMC criteria using the insights gained from this study. This was published in Journal of Medical Ethics. 3. We are continuing to analyze interviews with judges, lawyers, and psychiatrists regarding their views of the practice of capacity assessments under the MCA in England/Wales, especially regarding what each discipline considers difficult cases. This is a qualitative anlaysis; we expect our first paper to be completed in the upcoming year. 4. The Mental Capacity Act provides for how to make decisions for incapacitated persons, largely focusing on the persons previous statements, expressed values, beliefs, and preferences that are then used to define what is in the person's best interests. This is somewhat unusual as it seems to define a person's 'best interests' in terms of what is often called a 'substituted decision' standard. We are using a recent Court of Protections case to delineate the potentially problematic practical and conceptual consequences of this kind of framework for surrogate decision-making. This project's results has been published. See biblio. 5. A controversial issue that arose during debates over resource allocation during the earlier days of COVID pandemic: What is the proper role, if any, of age and disability (especially neurocognitive disorders) related conditions on how scarce resources are to be allocated? This project prepares for a future deliberation study on this topic. The data collection was carried out by a research team at KCL and the results were published during this year.