Decision-making capacity in clinical and research settings

Clinical Center

Investigators

Linked publications & trials

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). We then conducted a follow up 'critical normative analysis' 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. 2. 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." We completed our first analysis, focusing on the challenging cases as described by experienced consultation psychiatrists. 3. One of the most persistent debates in bioethics and law regarding decision-making capacity is whether the threshold for having capacity should be sensitive to risk. Many see this as intuitive and obvious. Others see it as dangerously paternalistic. We conducted a systematic literature review of this debate over risk sensitive DMC. Using the review, we are developing a comprehensive defense of RS DMC, addressing all of the key objections against it.