In the Spring and Summer of 2014, a group of experts convened a series of meetings at the Westminster headquarters of the UK Ministry of Justice in order to determine whether the Mental Capacity Act 2005 complies with the United Nations Convention on the Rights of Persons with Disabilities. The meetings were organised by the research team of the Essex Autonomy Project, a research and public policy initiative funded by the Arts and Humanities Research Council and based at the University (...) of Essex. The working group included civil servants from the MoJ, the Office of the Public Guardian, and the Department of Health, as well as the Official Solicitor, a senior judge of the Court of Protection, leading academic experts from psychiatry, law and ethics, and representatives of user-group organisations. In September 2014, the EAP research team reported to the MoJ on its findings. This article summarises some of the key arguments and conclusions of that report. Both the report itself and this article represent the views of their respective authors; they should not be taken to represent the views of the MoJ, the AHRC, or the other participants in these consultations. (shrink)

The ‘best interests’ standard is a highly seductive standard in English law. Not only does it appear to be fairly uncontroversial but it also presents as the most sensible, objective and ‘fair’ method of dealing with decision making on behalf of those who are perceived to be the most vulnerable within society. This article aims to provide a critical appraisal of how the standard has been applied within family law, to outline how the standard is to be applied within healthcare (...) law and, finally, to assess the relevance of the family law experience of the best interests standard to the operation of the standards as envisaged by the MCA. (shrink)

In this commentary on Stokoe’s article, ‘Moving forward with membership categorization analysis’, I take up the challenge to apply her keys for MCA to an extract of conversation recorded in a restaurant. The strengths of conversation analysis have not included – and indeed have not attempted to achieve – successful engagement with beyond-the-immediate-talk aspects of culture and the commonsense workings of society. The aim of the article is to explore what MCA might add to an analysis of a stretch of (...) talk using conversation analytic tools. It was found that a systematic application of the keys did indeed provide a richer account of what was going on. Whereas categories alone did not appear to provide more insights than commonsense can tell us, when the broader array of MCA tools and keys were applied, an enhanced analysis of the passage of talk emerged. An exploration of whether this can be extended as a method for a rigorous investigation of culture and society while still being grounded in participants’ mutual, moment-by-moment orientations to categories seems at the very least worth the serious attention of scholars interested in interaction. (shrink)

Background and Purpose The decision to perform decompressive craniectomy for patients with malignant MCA syndrome can be ethically complex. We investigated factors that clinicians consider in this decision-making process. Methods A survey including clinical vignettes and attitudes questions surrounding the use of hemicraniectomy in malignant MCA syndrome was distributed to 203 neurosurgeons, neurologists, staff and residents, and nurses and allied health members specializing in the care of neurological patients. These were practicing health care providers situated in an urban setting in (...) Canada where access to health care is covered by national policy and is a human right. Results Eighty-eight participants responded to survey. All participants unanimously supported the procedure for young and healthy patients. Advanced age, the presence of aphasia, comorbid medical conditions, and poor baseline functional status were dominant factors associated with increasing reluctance to offer surgical decompression. Patients’ previously expressed wishes were also an important consideration. Eighty-six percent of respondents agreed that withholding surgery is ethically justified if the outcome is perceived as futile. Conclusions Health care providers use similar factors to determine if aggressive management is justified given anticipated burden on patient quality of life and extended impact on society. This convergence can be harnessed beneficially for the transparent communication of medical options in the ethically complex setting of decompressive hemicraniectomy post-stroke. (shrink)

Metacognition, the cognition about cognition, is closely linked to intelligence and therefore understanding the metacognitive processes underlying intelligence test performance, specifically on Raven’s Progressive Matrices, could help advance the knowledge about intelligence. The measurement of metacognition, is often done using domain-general offline questionnaires or domain-specific online think-aloud protocols. This study aimed to investigate the relationship between metacognitive awareness and intelligence via the design and use of a novel Meta-Cognitive Awareness Scale – Domain Specific that encourages reflection of task strategy processes. (...) This domain-specific scale was first constructed to measure participants’ awareness of their own metacognition linked to Raven’s Progressive Matrices. Following discriminatory index and Exploratory Factor Analysis, a 15-item scale was derived. Exploratory Factor Analysis showed five factors: Awareness of Engagement in Self-Monitoring, Awareness of Own Ability, Awareness of Responding Speed/Time, Awareness of Alternative Solutions and Awareness of Requisite Problem-Solving Resources. The intelligence level of ninety-eight adults was then estimated using Raven’s Standard Progressive Matrices. Participants also completed the MCAS-DS, and further items that examined their test-taking behavior and Confidence level. Metacognitive awareness was positively correlated to standardized IQ scores derived from the SPM whilst Over-Confidence derived using the Confidence level measure was negatively correlated to SPM. Despite some limitations, this study shows promise for elucidating the relationship between metacognitive awareness and intelligence using the task-specific scale. (shrink)

The unborn healthy foetus is looked upon as a blessing by one and all. A plethora of thoughts arise in the brains of expectant parents. But what goes on in the brain of the yet unborn still remains a mystery. 'Foetal mind' is a reflection of functions of its organs of sense, an instrument of knowledge that may even be reduced to machine to demonstrate the effect of sense organs and brain contact. Testimony to this fact are the various waveform (...) patterns obtained non-invasively from the foetal Middle Cerebral Artery (MCA) by using Colour Doppler Ultrasound. Our study, conducted for evaluating the foetal MCA in a rural obstetric population in Maharashtra, India, explains how the MCA - a major artery supplying foetal brain, can give abundant information about foetal heart and foetal stress. When only the foetal heart is stressed by the presence of arrhythmias or ectopic beats, these changes are manifest in the foetal MCA velocity waveform pattern as seen on Colour Doppler study. When the entire foetus is under stress, as in cases of intra uterine growth retardation (IUGR), changes again manifest in the foetal MCA velocity waveform pattern and are designated as the foetal Brain Sparing Effect. Thus scientific evaluation of foetal MCA waveform can objectively demonstrate that the overtly non-communicating foetal brain indeed remains an internal organ of sense and a vital instrument of knowledge to clarify the various effects of sense organs and brain contact. Although the brain parenchyma or cerebral metabolism has not been studied here, cerebral vessels serve as a window to cerebral metabolism, as auto regulatory function of brain leads to changes in haemodynamics of cerebral vessels. Also, like other vessels, MCA mirrors foetal distress and IUGR; but unlike other vessels, e.g. the umbilical or uterine artery, which show these changes in the form of reduction or even reversal of diastolic flow, MCA shows an increase in diastolic component due to brain sparing effect. The unique connection between physical changes in the foetal heart, brain and mental operations are thus critically clarified to some extent, and this helps untangle and comprehend the lattice of mental operations. Although this preliminary study has its limitations, it still carries forward the present corpus of knowledge on the strength of its evidential and critical enquiry and helps unravel the concept of foetal consciousness. (shrink)

In recent years, the debate on emotions has been influenced by postconstructionist research, particularly the use of performativity as a key concept. According to Judith Butler (1993, 1997) the construction of emotions is a process open to constant change and redefinition. The final result of emotionlanguage “natural” development is what is known as technoscience. New ways of naming emotions have emerged within technoscience. In our research on the use of information and communication technologies (ICT) by cyber-café and call shop users, (...) we came to understand how these technologies are significant in those users’ daily life. The emphasis will be on analyzing emotions related to the use of ICT in the aforementioned settings. Using the concept of performance (Butler, 1990), we will explore how narratives create a need for particular emotions, which did not exist before they were performed. To understand this performance, we use an ad hoc tool called Membership Categorization Analysis (MCA) as it is used by the Manchester School. Analysis has revealed the existence of a membership category in which velocity is salient as performance. This ‘velocity’ seems to follow the evolution of technoscience in the social sciences. We will observe velocity in the context created by two concepts, Donna Haraway’s (1990) cyborg and Alessandro Baricco’s (2007) mutant. (shrink)

Malaysian voters made a historical decision in May 2018, ushering in what observers termed a “Malay political tsunami” by displacing the UMNO government’s decades-long rule. This paper argues that the spirit of inclusiveness played a crucial role in the first transition of power in Malaysia. Moreover, the inclusive representation of major ethnic groups in the multi-racial state by the winning Alliance Hope coalition was a key factor leading to the transition. This paper also examines the political development in Malaysia, from (...) the beginning of inclusive politics in the early stage of its independence, to the decline of inclusiveness from the 1970s to 1990s, to the collapse of the inclusive politics since 2008 when the DAP produced a major victory over the MCA in the May 2008 elections. Finally, this paper also explores the challenges of the new ruling Alliance Hope in Malaysia. Keywords : Ethno-politics, inclusiveness, UMNO, MCA, MIC, Alliance Hope. (shrink)

This article has four aims. First, it will consider explicitly, and polemically, the hierarchical relationship between conversation analysis and membership categorization analysis. Whilst the CA ‘juggernaut’ flourishes, the MCA ‘milk float’ is in danger of being run off the road. For MCA to survive either as a separate discipline, or within CA as a focus equivalent to other ‘generic orders of conversation’, I suggest it must generate new types of systematic studies and reveal fundamental categorial practices. With such a goal (...) in mind, the second aim of the article is to provide a set of clear analytic steps and procedures for conducting MCA, which are grounded in basic categorial and sequential concerns. Third, the article aims to demonstrate how order can be found in the intuitively ‘messy’ discourse phenomenon of membership categories, and how to approach their analysis systematically as a robust feature of particular action-oriented environments. Through the exemplar analyses, the final aim of the article is to promote MCA as a method for interrogating culture, reality and society, without recourse to its reputed ‘wild and promiscuous’ analytic approach. (shrink)

Two separate regulatory regimes govern research with adults who lack capacity to consent in England and Wales: the Mental Capacity Act (MCA) 2005 and the Medicines for Human Use (Clinical Trials) Regulations 2004 (“the Regulations”). A service evaluation was conducted to investigate how research ethics committees (RECs) are interpreting the requirements. With the use of a coding scheme and qualitative software, a sample of REC decision letters where applicants indicated that their project involved adults who lacked mental capacity was analysed. (...) The analysis focuses on 45 letters about projects covered by the MCA and 12 letters about projects covered by the Regulations. The legal requirements for involving incapacitated adults in research were not consistently interpreted correctly. Letters often lacked explicitness and clarity. Neither consent nor assent from third parties is a legally valid concept for purposes of the MCA, yet they were suggested or endorsed in 10 post-MCA letters, and there was evidence of confusion about the consultee processes. The correct terms were also not consistently used in relation to clinical trials. Inappropriate use of terms such as “relative” had the potential to exclude people eligible to be consulted. Unless the correct terms and legal concepts are used in research projects, there is potential for confusion and for exclusion of people who are eligible to be consulted about involvement of adults who lack capacity. Improved clarity, explicitness and accuracy are needed when submitting and reviewing applications for ethical review of research in this area. (shrink)

In 2018-2019, at the Keck School of Medicine of the University of Southern California, we developed and piloted a narrative-based health systems science intervention for patients living with HIV and medical students in which medical students co-wrote patients’ life narratives for inclusion in the electronic health record. The pilot study aimed to assess the acceptability of the “life narrative protocol” from multiple stakeholder positions and characterize participants’ experiences of the clinical and pedagogical implications of the LNP. Students were recruited from (...) KSOM. Patients and staff were recruited from the Maternal, Child, and Adolescent/Adult Center for Infectious Disease and Virology at Los Angeles County+USC Medical Center. Ten patients, seventeen students, and ten MCA staff participated in the pilot study. Qualitative methods were used to gather data from students’, patients’, and staff’s perspectives. Three themes emerged from the thematic analysis: patients’ life narratives conveyed their unique life experiences and voices; the protocol could result in wide-ranging effects on HIV care; the LNP enabled students to contribute value to patients’ healthcare. Across groups, participants considered the LNP an acceptable intervention. The LNP, its limitations, and implications for HIV care, narrative medicine, and health information technology are presented. (shrink)

I present considerations surrounding pre-reflective self-consciousness, arising in work I am conducting on a new physicalist, process-based account of [phenomenal] consciousness. The account is called the meta-causal account because it identifies consciousness with a certain type of arrangement of meta-causation. Meta-causation is causation where a cause or effect is itself an instance of causation. The proposed type of arrangement involves a sort of time-spanning, internal reflexivity of the overall meta-causation. I argue that, as a result of the account, any conscious (...) process has PRSC. Hence, PRSC does not need to be taken as a stipulation or argued for on purely phenomenological grounds or as a necessary support for reflective consciousness. I also show how it is natural to the account that PRSC is not an additional, peripheral, sort of consciousness, but is intrinsic to all consciousness, thereby fitting claims about self-intimation and co-constitution by various authors, and also being amenable to an adverbial account. As part of this, consciousness of an external object is just the form that current self-consciousness takes, the meta-causal constitution of it being inextricably modulated by the causal relationship with the object. The article also discusses how MCA helps explore issues of for-me-ness, transparency of perceptual consciousness, and possible immediacy and non-relationality of self-consciousness. (shrink)

In the context of agricultural activity intensification and rural abandonment, neo-rurality has emerged as a back-to-the-land migratory movement led by urban populations seeking alternative ways of life close to nature. Although the initiatives of the new peasantry are diverse, most are land related, such as agriculture and livestock farming. A priori, neorural people undertake agri-food system activities in ways that differ from the conventional model, following the principles of environmental and social sustainability. We conducted a systematic review of the literature (...) on the neo-rural phenomenon with the main objective of examining how neo-rurality has been found to support agroecological transitions. The corpus of neo-rural studies was analyzed from a social-ecological perspective, and a Multiple Correspondence Analysis (MCA) was conducted to determine whether neo-rural agri-food system activities follow agroecological principles. The results indicate that neo-rural studies is an emerging research field that has received considerable attention in western countries. Diverse conceptualizations and terms have been used to address the phenomenon, but the literature agrees on political and environmental motivations and several barriers faced by neo-rural people. This population and in particular new peasants, are employing a wide variety of agroecological practices and strategies throughout the agri-food system. Overall, neo-rural people have been reported to contribute significantly to agroecological transition. (shrink)

The Treatment Escalation Plan (TEP) was introduced into our trust in an attempt to improve patient involvement and experience of their treatment in hospital and to embrace and clarify a wider remit of treatment options than the Do Not Resuscitate (DNR) order currently offers. Our experience suggests that the patient and family are rarely engaged in DNR discussions. This is acutely relevant considering that the Mental Capacity Act (MCA) now obliges these discussions to take place. The TEP is a form (...) that the doctor completes, ideally with the competent patient or close relative, documenting what treatment options would be appropriate if that patient were to become acutely unwell. Ventilation of the lungs, cardiac resuscitation, renal replacement therapy, intravenous fluids and antibiotics are all discussed. The study evaluated patient and relative experiences with the TEP. 55 patients or their relatives were interviewed regarding their experience of the TEP and thoughts regarding the process. 96% of patients and relatives evaluated thought that the TEP was a good idea. Free text comments were all positive and only 34% of patients claimed to feel anxious when completing the form. Following this study, the TEP has been expanded hospital wide and into the community within our trust. Discussions are currently taking place in hospitals within our region to introduce the TEP form into other local trusts. (shrink)

The Deprivation of Liberty Safeguards (DOLS) were recently introduced into the Mental Capacity Act (MCA) via an amendment to mental health legislation in England and Wales. As Shah (2011) discusses, the rationale behind creating these protocols was to close what is commonly referred to as the ‘Bournewood gap’; a legislative loophole that allowed a severely autistic man (H.L.) who did not initially dissent to admission to be detained in a hospital and deprived of his liberty in his ‘best interests’ as (...) judged by his clinical team. Before the implementation of the DOLS, patients who lacked the capacity to consent to admission or treatment but who were nonetheless compliant could be admitted informally and treated as .. (shrink)

This special issue, Withholding artificial nutrition and hydration, comprises several papers, commentaries and responses centred largely around the issues raised by the 2011 decision of the English Court of Protection in W v M.i In that case, the mother of an adult patient applied for the withdrawal of life-sustaining treatment . In 2003, the patient, M, had contracted viral encephalitis and suffered irreparable brain damage as a result. She fell into a coma, and when she emerged appeared to be in (...) a vegetative state and for 8 years was entirely dependent on life-sustaining care.Following her mother's application, M was held to lack capacity and hence in accordance with section 4 of the Mental Capacity Act 2005 , the matter turned on whether it was in her best interests for the treatment to be withdrawn. It was made clear in the 1993 decision of Airedale NHS Trust v Bland that life-sustaining treatment could be withdrawn from a patient in a permanent vegetative state if, on balance, it was not in his or her interest to continue treatment.ii The MCA also allows for withdrawal of treatment, although the approach to best interests is slightly different. However, the case of W v M is importantly different from the Bland case, because M was found not to be in a PVS, but instead was minimally conscious . Much evidence was presented of her capacity to respond to stimuli, seemingly express emotion and occasionally speak.In the first of his papers in this issue , Julian Sheather provides an overview of the case, particularly illuminating the discussions of M's interests and the views of her …. (shrink)

The Mental Capacity Act 2005 gives statutory force to the common law principle that all adults are assumed to have capacity to make decisions unless proven otherwise. In accord with best practice, this principle places the evidential burden on researchers rather than participants and requires researchers to take account of short-term and transient understandings common among some research populations. The aim of this paper is to explore some of the implications of the MCA 2005 for researchers working with 'vulnerable' populations (...) in health and social care settings. The Cyclical Consent Model is described and offered as a process by which researchers might develop good practice when engaged in research involving vulnerable people. (shrink)

This book presents the methodological framework of combining Multimodal Conversation Analysis (MCA) with Interpretative Phenomenological Analysis (IPA) to interpretively analyse translanguaging practices in educational contexts. Beginning with an overview of the three uses of translanguaging - translanguaging as a theory of language, as a pedagogical practice and as an analytical perspective - the book goes on to critically examine the different methodological approaches for analysing translanguaging practices in multilingual classroom interactions. It explains how MCA and IPA are useful methodologies for (...) understanding how and why translanguaging practices are constructed by participants in the classroom and discusses types of data collected and data collection procedures. The author, Kevin W. H. Tai, shows how combining these approaches enables researchers to study how translanguaging practices are constructed in multilingual classrooms and how teachers make sense of their own translanguaging practices at particular moments of classroom interaction. This detailed and concise guide is indispensable for students, practitioners, policymakers, and researchers from across the globe, particularly those working in the fields of applied linguistics and language education. (shrink)

The recent resurgence of Sacks’ work on membership categorization has highlighted the growing analytic interest in how members’ social category orientations operate at multiple levels of interactional work. One of the outcomes of this, highlighted in Stokoe’s discussion, is the re-emergence of the question of whether membership categorization analysis has been, is, or can be an approach in its own right. In this brief discussion I consider the emergence of ‘MCA’ as an approach to the study of social-knowledge-in-action, the relationship (...) between MCA and contemporary directions in conversation analysis, and finally the future of MCA as it continues to develop. (shrink)

Professor Charles Foster1 argues that the recent decision by the Supreme Court2 on the process of making decisions about medical treatment in people who lack capacity due to a prolonged disorder of consciousness is fostering medical paternalism. He considers that the judgment shows ‘ deference to the guidelines of various organisations ’ and then that ‘ The guidance has effectively become a definitive statement of the relevant obligations,’ concluding that ‘ This usurps the function of the law.’ Healthcare teams make (...) all decisions concerning medical care provided; no-one else can. Both the clinicians themselves, and any guidance provided to them, must comply with the Mental Capacity Act 2005.3 Lady Black’s judgment makes clear that ‘ The basic protective structure is established by the MCA 2005 ’ and that the associated Code of Practice4 ‘ contains valuable guidance ’. She specifically highlights that the decision-maker must ensure that ‘ account has been taken of the patient’s previously expressed wishes and those of people close to him, as well as the opinions of other medical personnel. The MCA 2005 requires this to happen, and is reinforced by the professional guidance available to doctors.’ The Act says: ‘ He must consider, so far as is reasonably ascertainable— 1. the person’s past and present wishes and feelings (and, in …. (shrink)

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one’s decision. But interpreting and applying broad and vague criteria, such as the ability ‘to use or weigh’ to a diverse range of presentations is challenging. By examining actual court judgements of (...) capacity, we previously developed a descriptive typology of justifications used in the application of the Mental Capacity Act criteria. We here critically optimise this typology by showing how clear definitions—and thus boundaries—between the criteria can be achieved if the ‘understanding’ criterion is used narrowly and the multiple rationales that fall under the ability to ‘use or weigh’ are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA. No data are available. This paper does not report any original data. (shrink)

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this (...) process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)

This paper considers the potential for the Mental Capacity Act of England and Wales to incentivise the exclusion of people with dementia from research. The MCA is intended to standardise and...

The right to active participation by disabled people in academic research has been discussed at length in recent years, along with the potential for such research to function as a tool in challenging oppression and pursuing disability rights. Significant ethical, legal and methodological dilemmas arise, however, in circumstances where a disabled person loses the capacity to provide informed consent to such participation. In this article, I consider disability politics and academic research in the context of the Mental Capacity Act 2005, (...) which sets out in Anglo-Welsh law the circumstances and requirements for research participation by individuals lacking the capacity to provide informed consent. Drawing on my own perspective on research participation in relation to physical and psychosocial disability, I consider the implications of my potential future loss of capacity for my right to participate in disability-related research. I examine the barriers to such participation and suggest that partial solutions may be found in the advance decision-making and advance care-planning frameworks of the MCA 2005 and related policy, but that current legislative and policy frameworks nevertheless still curtail my rights with regard to research participation on loss of capacity to consent. In so doing, I seek to provoke debate concerning what this legislative provision means for the disability rights movement, and the possibilities and challenges it presents to the movement’s commitment to ‘nothing about us without us’. (shrink)

Principle 2 of the 2005 Mental Capacity Act (MCA) requires that decision-making capacity should be assumed, unless there is conclusive evidence, on a balance of probabilities, to the contrary (Department of Constitutional Affairs 2005). In his article “The Paradox of the Assessment of Capacity Under the Mental Capacity Act 2005,” Ajit Shah (2011) raises the concern that the new Deprivation of Liberty Safeguards (DOLS), introduced through the Mental Health Act (Department of Health 2007), conflict with this principle (henceforth, the principle (...) of presumed capacity) because, in practice, they will encourage the routine assessment of capacity even in the absence of any positive evidence of diminished capacity .. (shrink)

BackgroundThe Mental Capacity Act was enacted in 2007 in England and Wales, but the assessment of mental capacity still remains an area of professional concern. Doctors’ compliance with legal and professional standards is inconsistent, but the reasons for poor compliance are not well understood. This preliminary study investigates doctors’ experiences of and attitudes toward mental capacity assessment.MethodsThis is a descriptive, cross-sectional study where a two-domain, study-specific structured questionnaire was developed, piloted and digitally disseminated to doctors at differing career stages employed (...) in a large, multi-site National Health Service Trust in London over 4 months in 2018. Descriptive statistics and frequency tables adjusted for missing data were generated and secondary analysis was conducted.ResultsParticipants were predominantly UK trained, female and between the ages of 30 and 44 years. Less than half of the participants reported receiving formal MCAx training. Only one-third of the participants self-rated themselves as very competent or extremely competent. Self-reported MCA confidence was significantly affected by career stage with Consultants with over 10 years of experience reporting lowest confidence.ConclusionsThis study describes significant variation in practice by doctors and low self-confidence in the practice of MCAx. These results raise concerns that MCAx continues to be inconsistently performed by doctors despite appropriate awareness of the law and professional guidance on best practice. (shrink)

The anthropological approach to mental competence is very interesting. I shall reason that the issue of mental competence and the determination best interests in the decision making process has been integrated together in this anthropological approach. I use the relatively recent Mental Capacity Act 2005 (MCA) for England and Wales (Department of Constitutional Affairs 2005) to illustrate this line of reasoning. I have deliberately chosen the phrase decision-making capacity (DMC) in this commentary to separate it from the concept of determination (...) of best interests. I am writing from the perspective of an old-age psychiatrist who frequently has to assess DMC and make decisions on behalf of those who lack .. (shrink)

The mental capacity Act 2005 (MCA; Department of Constitutional Affairs 2005) was partially implemented on April 1, 2007, and fully implemented on October 1, 2007, in England and Wales. The MCA provides a statutory framework for people who lack decision-making capacity (DMC) or who have capacity and want to plan for the future when they may lack DMC. Health care and social care providers need to be familiar with the MCA and the associated legal structures and processes. The MCA is (...) supported by a Code of Practice (Department of Constitutional Affairs 2007), which was developed after extensive consultation and includes case examples. Those involved in the assessment of DMC and the application of the MCA should .. (shrink)

Following Sacks's model membership categorization analysis (MCA) of a suicidal person's conclusion 'I have no one to turn to,' the paper examines in MCA terms a political actor's twin conclusions that murder-suicide is a rational course of action. The case in question is the killer's reasoning in the Montreal Massacre as revealed in his reported announcement at the scene (notably 'You're all a bunch of feminists. I hate feminists') and recovered suicide letter (for example, 'For why persevere to exist if (...) it is only to please the government'). (shrink)

This paper provides a provisional examination of Rod Watson ''s work and contributions to EM/CA/MCA, in part through a critique of misrepresentations of his arguments in secondary accounts of his work. The form of these misrepresentations includes adumbration and traducement of his arguments. Focusing on the reflexivity of category and sequence and turn-generated categories, we suggest that his analytic position within ethnomethodological fields is unique and remarkable, yet largely unacknowledged. We argue that a re-examination of the body of Watson ''s (...) work makes relevant explicit and appropriate acknowledgement of his contributions through his unconventional approach and his extension of prior works in novel and stimulating directions. (shrink)

This paper investigates how the reader of prose fiction fills in the blanks regarding a fictional character’s membership category, action, and reason for the action. Aligning with an ethnomethodological approach to texts and appropriating membership categorization analysis (MCA), we analyze how the readers of J. D. Salinger, an author whose works are well known for their ambiguity and ambivalence, would grasp the unwritten identities of characters and the meanings of their actions. Our analysis specifies two types of methods deployed for (...) the reader to understand the fictional texts. First, in an at-a-glance way, the reader can supply the missing categories and sequence of actions by turning to the commonsense knowledge and social norms regarding the association between the category and the activity. Second, the reader can construct various interpretations regarding the recognizably ambiguous scenes of the text by turning to the conceptual knowledge of the relevant social phenomena, the maxims specific to the act of storytelling, and the writer’s techniques peculiar to the fictional texts. The findings demonstrate the vast applicability of an MCA approach to the analysis of the work of reading prose fiction and shed light on the detailed operations of the author’s maxims and techniques in the textual configuration of prose fiction, thereby indicating the possibility of ethnomethodological analysis including the interwoven consideration of the reader’s activity and the textual organization. (shrink)

-/- Following the Mental Capacity Act (MCA) becoming law in 2005, and prior to its coming into force in 2007, there was a sustained effort to train support staff in the many social care settings where this new law was applicable. This training drive was necessary because, prior to the MCA, mental capacity law had evolved in the courts through consideration of a small number of cases that concerned serious medical treatments. These included the withdrawal of artificial nutrition and hydration (...) (Airedale NHS Trust v. Bland [1993]), blood transfusion (Re T [1993]), tissue donation (Re Y [1997]) and the provision of experimental medication for terminal illness (Simms v. Simms and another (2003)). In line with the Law Commission’s recommendations, the MCA extended the application of the law to ‘all acts in connection with care or treatment’ (MCA, Section 5), meaning that, overnight, social care settings and informal family care environments immediately fell within the scope of the legislation. (shrink)

BackgroundSonographic mesenteric pattern in celiac disease (CD) suggests a hyperdynamic circulation. Despite the well-known CD-related neurological involvement, no study has systematically explored the cerebral hemodynamics to transcranial Doppler sonography.Materials and methodsMontreal Cognitive Assessment (MoCA) and 17-item Hamilton Depression Rating Scale (HDRS) were assessed in 15 newly diagnosed subjects with CD and 15 age-, sex-, and education-matched healthy controls. Cerebral blood flow (CBF) velocities and indices of resistivity (RI) and pulsatility (PI) from the middle cerebral artery (MCA), bilaterally, and the basilar (...) artery (BA) were recorded. We also assessed cerebral vasomotor reactivity (CVR) through the breath-holding test (BHT).ResultsWorse scores of MoCA and HDRS were found in patients compared to controls. Although patients showed higher values of CBF velocity from MCA bilaterally compared to controls, both at rest and after BHT, no comparison reached a statistical significance, whereas after BHT both RI and PI from BA were significantly higher in patients. A significant negative correlation between both indices from BA and MoCA score were also noted.ConclusionThese treatment-naïve CD patients may show some subtle CVR changes in posterior circulation, thus possibly expanding the spectrum of pathomechanisms underlying neuroceliac disease and in particular gluten ataxia. Subclinical identification of cerebrovascular pathology in CD may help adequate prevention and early management of neurological involvement. (shrink)

Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative study, (...) we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions. (shrink)

Under the Mental Capacity Act 2005 (MCA) in England and Wales, the liberal commitments to subjective freedom guide obligations towards persons who do not lack capacity. For the subject of proceedings who might lack capacity (P), it is less clear as to what obligations orient best interests decision-making on their behalf. The UK Supreme Court has emphasised the centrality of ‘P-centricity’ in best interests decision-making, where there is the legal obligation to consider P’s subjective views and wishes in a holistic (...) consideration of best interests. Unclarity nonetheless persists as to what is owed to P in the best interests standard, leading to the tendency to interpret obligations of P-centricity through the normative prism of subjective autonomy. This paper argues that such moves reduce the complex moral phenomenology of what a P-centric ethos entails. Instead, the phenomenological and ethical stance of moral considerability and recognition respect can best capture the enriched normative grounding for P-centric decision-making in mental capacity law. (shrink)

In this article, I address some of the issues for the analysis of categorial features of talk and texts raised by Stokoe’s ‘Moving forward with membership categorization analysis: Methods for systematic analysis’. I begin by discussing a number of points raised by Stokoe, relating to previous conversation analytic work that has addressed categorial matters; the implicit distinction in her article between ‘natural’ and ‘contrived’ data; and ambiguity with respect to the relevance of categories, in particular practices or utterances. I then (...) discuss how my own previous work could be located in light of Stokoe’s discussion of debates and divergences between conversation analysis and membership categorization analysis, and argue that being bound by the integrity of the data on which an analysis is based should take precedence over attempting to characterize the analysis as exemplifying either a CA- or MCA-based approach. I conclude by calling for a commitment to doing analysis, and pointing to the value of the resources Stokoe offers in this regard. (shrink)

This paper considers the meaning of the term ‘intrusive research’, as used in the UK Mental Capacity Act 2005, in relation to studies in which an informant is asked to provide information about or on behalf of a person who lacks capacity to consent, and who is not otherwise involved in the study. The MCA defines ‘intrusive research’ as research that would legally require consent if it involved people with capacity. The relevant ethical principles are that consent should be sought (...) from people who would be affected by a piece of research and that this requirement should be implemented proportionately. The critical question, for investigators and research ethics committees, is: would provision of the personal information specified in the research protocol significantly affect a person whose capacity is not impaired? If the answer to this question is ‘no’, then the study falls outside the definition of ‘intrusive research’, and the MCA does not apply. (shrink)

This paper considers the meaning of the term ‘intrusive research’, as used in the UK Mental Capacity Act 2005, in relation to studies in which an informant is asked to provide information about or on behalf of a person who lacks capacity to consent, and who is not otherwise involved in the study. The MCA defines ‘intrusive research’ as research that would legally require consent if it involved people with capacity. The relevant ethical principles are that consent should be sought (...) from people who would be affected by a piece of research and that this requirement should be implemented proportionately. The critical question, for investigators and research ethics committees, is: would provision of the personal information specified in the research protocol significantly affect a person whose capacity is not impaired? If the answer to this question is ‘no’, then the study falls outside the definition of ‘intrusive research’, and the MCA does not apply. (shrink)

Our focus in this article is on some uses of categorial transformations. The discussion is divided into two main parts. In the first part, we begin by outlining our approach, namely membership categorization analysis (MCA), indicating the origins of the term and elaborating the conception of MCA as an ‘occasioned’ members’ apparatus. We then explain what we mean by the concept of categorial transformation, review some of the very few previous studies which have investigated this phenomenon and which are pertinent (...) to its further study, and indicate how categorial transformation serves to embody and illustrate the occasionality of MCA. In the second part of the article, we present an analysis of two extracts from a transcript of the naturally occurring talk-in-interaction which occurred in a particular family meal, involving two children and their parents. A variety of categorial transformation practices in this data are identified and their particular local usages described. In the concluding discussion we consider our argument and our analysis in light of previous discussions of the trajectory of Sacks’ work. (shrink)

This article comments briefly on three specific issues in Shazia Choudhry’s paper “‘Best Interests’ What can healthcare law learn from family law?” The three issues are: (1) the implications of ‘best interests’ and ‘welfare science’ for women within the family law and the health care law context, (2) the risk of capture by the ‘welfare science’ industry, and (3) the proposal that a committee of medical experts and medical ethicists should be set up to provide reports to the Court of (...) Protection on cases brought under the Mental Capacity Act 2005 (MCA). I argue that the risk of capture by ‘welfare science’ is equally large in health care law and that a committee of the kind envisaged by Choudhry is unlikely to contribute significantly to conflict resolution under the MCA. (shrink)