The Mental Capacity Act received Royal Assent on 7 April 2005, and it will be implemented in 2007. The Act defines when someone lacks capacity and it supports people with limited decision-making ability to make as many decisions as possible for themselves. The Act lays down rules for substitute decision making. Someone taking decisions on behalf of the person lacking capacity must act in the best interests of the person concerned and choose the options least restrictive (...) of his or her rights and freedoms. Decision making will be allowed without any formal procedure unless specific provisions apply, such as a written advance decision, lasting powers of attorney or a decision by the court of protection. (shrink)

The Mental Capacity Act, which received Royal Assent in April 2005, will come into force in April 2007. The Act puts into statute the legality of interventions in relation to adults who lack capacity to make decisions on their own behalf. The aim of this paper is to outline the main features of the legislation and its impact on those health care professionals who provide care and treatment for incapacitated adults. The paper sets out the underlying ethical (...) principles that govern interventions under the Act's powers and briefly explores the legal definition of incapacity and the process by which capacity is assessed. It looks at the governing notion of 'best interests' and at the legal indemnity provided by the Act for interventions that are in the best interests of an incapacitated adult. It contains sections on the Act's main innovations, including research involving incapacitated adults, lasting powers of attorney and the new Court of Protection. It also provides information on advance decisions to refuse treatment. (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)

This article considers the provisions of the Mental Capacity Act 2005 in respect of advance decisions. It considers the new statutory regulation of advance directives (termed 'advance decisions' in the Act) and the formalities necessary to effect an advance decision purporting to refuse life-sustaining treatment. The validity and applicability of advance decisions is discussed with analogy to case law and the clinician's reasonable belief in following an advance decision is considered. The article assesses the new personal welfare Lasting (...) Powers of Attorney, the situation where an attorney purports to refuse life-sustaining treatment on behalf of the donor, and the contrast between best interests and substituted judgment. (shrink)

The hospital's clinical ethics committee sought to gauge health-care professionals’ level of knowledge and usage of the Mental Capacity Act 2005 within the hospital trust. The hospital's personnel were asked to complete a 10 part questionnaire relating to the basic contents of the Act. Four hundred questionnaires were distributed and 249 (62%) were returned completed and valid for analysis. A ‘pass-mark’ of 70% (7/10) was assumed; the results showed that 48% of respondents scored ≤50% (≤5/10), 74% of respondents (...) scored <70% (<7/10) and only 24% of respondents scored ≥70% (≥7/10). It was concluded that the Mental Capacity Act 2005 was not being effectively implemented within the Trust. Measures to increase the awareness and usage of the Act have subsequently been instigated. We believe that these measures will improve the awareness and knowledge of the Mental Capacity Act 2005 within the hospital Trust lead to its better utilization. (shrink)

This article sets out a scenario highlighting some of the issues to be faced by NHS hospitals when dealing with patients who may require treatment under the Mental Capacity Act 2005. The article sets out matters to consider when dealing with patients in A&E, assessments of best interests, emergency treatment, lasting powers of attorney and transferring patients to nursing homes. All of these matters come under the remit of the Act.

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)

The Mental Capacity Act is an impressive piece of legislation that deserves serious ethical attention, but much of the commentary on the Act has focussed on its legal and practical implications rather than the underlying ethical concepts. This paper examines the approach that the Act takes to best interests. The Act does not provide an account of the underlying concept of best interests. Instead it lists factors that must be considered in determining best interests, and the Code of (...) Practice to the Act states that this list is incomplete. This paper argues that this general approach is correct, contrary to some accounts of best interests. The checklist includes items that are unhelpful. Furthermore, neither the Act nor its Code of Practice provides sufficient guidance to carers faced with difficult decisions concerning best interests. This paper suggests ways in which the checklist can be developed and discusses cases that could be used in an updated Code of Practice. (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)

The Mental Capacity Act 2005 came into force in England and Wales in 2007. Its primary purpose is to provide “a statutory framework to empower and protect people who may lack capacity to make some decisions for themselves.” Examples of such people are those with dementia, learning disabilities, mental health problems, and so on. The Act also gives those who currently have capacity a legal framework within which they can make arrangements for a time when (...) they may come to lack it. Toward this end, it allows for them to make advance decisions or to appoint proxy decision makers with lasting powers of attorney. (shrink)

This paper considers concerns that social care research may be stifled by health-focused ethical scrutiny under the Mental Capacity Act 2005 and the requirement for an ?appropriate body? to determine ethical approval for research involving people who are deemed to lack capacity under the Act to make decisions concerning their participation and consent in research. The current study comprised an online survey of current practice in university research ethics committees (URECs), and explored through semi-structured interviews the views (...) of social researchers engaged in or exploring work concerning people who may, under the Act, lack the capacity to make decisions to consent to participate in a research programme. The paper concludes that there was a lack of overt knowledge of and reference to the implications of the Act for research and some concerns that a restrictive focus on health-related scrutiny might prevent social care research from taking place. There was also a degree of creativity shown by social care researchers in responding to changing demands and a wish to assist people in making decisions to participate where possible. (shrink)

In 2014 the Essex Autonomy Project undertook a six month project, funded by the AHRC, to provide technical advice to the UK Ministry of Justice on the question of whether the Mental Capacity Act is compliant with the United Nations Convention on the Rights of Persons with Disabilities. Over the course of the project, the EAP research team organised a series of public policy roundtables, hosted by the Ministry of Justice, and which brought together leading experts to discuss (...) and debate the issues. A one-day public conference was held at the Institute for Government in July. In September 2014, the EAP research team submitted its findings to the Ministry of Justice. (shrink)

In 2014 the Essex Autonomy Project undertook a six month project, funded by the AHRC, to provide technical advice to the UK Ministry of Justice on the question of whether the Mental Capacity Act is compliant with the United Nations Convention on the Rights of Persons with Disabilities. Over the course of the project, the EAP research team organised a series of public policy roundtables, hosted by the Ministry of Justice, and which brought together leading experts to discuss (...) and debate the issues. A one-day public conference was held at the Institute for Government in July. In September 2014, the EAP research team submitted its findings to the Ministry of Justice. (shrink)

The Mental Capacity Act will come into force in 2007. It sets out guidelines for the ethical review of research involving incompetent adults which will have an impact on the REC process. This paper attempts to explain the Act's requirements in a way that will give research ethics committees some clarity about what must be considered when reviewing applications. Potential difficulties have been highlighted with guidance as to how these might be resolved.

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)

The Mental Capacity Act 2005 placed for the first time research concerning adults lacking mental capacity upon a statutory footing. However, while the legislation which regulates the inclusion of such adults in ‘intrusive research’ safeguards researchers and research participants alike some controversy remains as to its implementation. This paper focuses upon two specific issues raised by the legislation. First, what constitutes ‘intrusive’ research and whether all issues concerning research involving adults lacking mental capacity should (...) be referred to NHS research ethics committees. Secondly, the role of one of the statutory safeguards–the ‘consultee’. These are individuals who are to be consulted regarding the inclusion of adults lacking mental capacity in research. It contrasts the ‘personal’ and ‘nominated’ consultees and considers whether there is a risk that the legislation may result in a new ‘quasi profession’ of consultees in the future. (shrink)

In 2014 the Essex Autonomy Project undertook a six month project, funded by the AHRC, to provide technical advice to the UK Ministry of Justice on the question of whether the Mental Capacity Act is compliant with the United Nations Convention on the Rights of Persons with Disabilities. Over the course of the project, the EAP research team organised a series of public policy roundtables, hosted by the Ministry of Justice, and which brought together leading experts to discuss (...) and debate the issues. A one-day public conference was held at the Institute for Government in July. In September 2014, the EAP research team submitted its findings to the Ministry of Justice. (shrink)

In 2014 the Essex Autonomy Project undertook a six month project, funded by the AHRC, to provide technical advice to the UK Ministry of Justice on the question of whether the Mental Capacity Act is compliant with the United Nations Convention on the Rights of Persons with Disabilities. Over the course of the project, the EAP research team organised a series of public policy roundtables, hosted by the Ministry of Justice, and which brought together leading experts to discuss (...) and debate the issues. A one-day public conference was held at the Institute for Government in July. In September 2014, the EAP research team submitted its findings to the Ministry of Justice. (shrink)

The law of England and Wales provides that an adult with capacity has the right to refuse medical treatment both contemporaneously and in an advance refusal. Legislation separates general advance refusals of treatment from advance refusals of life-sustaining treatment. The law, outlined in ss.24 to 26 of the Mental Capacity Act 2005, is stricter for creation of the latter. These sections brought with them a new age of interests by purporting to elevate individual autonomy as the primary (...) concern. Beginning with the classical tale of Odysseus and a general discussion of the value to be found in a law seeking to preserve individual autonomy, this thesis seeks to act as a critique of the current enactment in practice. The provisions are already under-used and under-applied; without change, they may never reach the stage where they are ethically and practically viable. It is argued that the advance refusals provisions are not taking full effect due to a combination of lacking moral grounding and general dismissal of key ethical dilemmas at the forefront of application. Building on this, the moral basis for this thesis is found in Alan Gewirth’s Principle of Generic Consistency (PGC) which links directly with the general application of human rights. The PGC becomes a compass for determining how best to treat persons when addressing the three most prominent challenges faced by the 2005 Act which are: the debate between the conferred right of autonomy versus the right to life; the issue of personhood; and, the personal identity problem. Ultimately, unless framework provisions are strengthened, and the Mental Capacity Act 2005 is rethought in light of prominent ethical, legal and social considerations, the constraints of the Act on paper will continue to suppress the important underlying values promulgating individual autonomy. (shrink)

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 (...) class='Hi'>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)

A new culture of care -- Maximising capacity -- Assessing capacity -- Advocacy and empowerment -- Advance care planning -- Best interests -- Liberty and choice.

The Mental Capacity Bill endangers the vulnerable by inviting human rights abuse. It is perhaps these grave deficiencies that prompted the warnings of the 23rd Report of the Joint Committee on Human Rights highlighting the failure of the legislation to supply adequate safeguards against Articles 2, 3 and 8 incompatibilities. Further, the fact that it is the mentally incapacitated as a class that are thought ripe for these and other kinds of intervention, highlights the Article 14 discrimination inherent (...) in this and related legislation. The financial, medical and research interests that underpin the legislation highlight how the legilsation endangers the ulnerable. It appears to be both a responsibility shifting exercise. Most alarmingly of all, efforts to permit non-therapeutic research on the non-consenting vulnerable as well as sterilisation and abortion on those who do not consent suggest that the legislation heralds a new era o gross human rights abuse in instutions around the UK. (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)

A diagnosis of schizophrenia is often taken to denote a state of global irrationality within the psychiatric paradigm, wherein psychotic phenomena are seen to equate with a lack of mental capacity. However, the little research that has been undertaken on mental capacity in psychiatric patients shows that people with schizophrenia are more likely to experience isolated, rather than constitutive, irrationality and are therefore not necessarily globally incapacitated. Rational suicide has not been accepted as a valid choice (...) for people with schizophrenia due in part to a belief that characteristic irrationality prevents autonomous decision-making. Since people with schizophrenia are often seen to lack insight into the nature of their disorder, both psychiatric and ethical perspectives generally presume that suicidal acts result directly from mental illness itself and not from second-order desires. In this article, I challenge notions of global irrationality conferred by a diagnosis of schizophrenia and argue that, where delusional beliefs are unifocal, schizophrenia does not necessarily lead to a state of mental incapacity. I then attempt to show that people with schizophrenia can sometimes be rational with regard to suicide, where this decision stems from a realistic appraisal of psychological suffering. (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 Mental Capacity Act (2005) was designed to protect and empower patients with impaired capacity. Despite an estimated 40% of medical inpatients lacking capacity, it is unclear how many patients undergo capacity assessments and treatment under the Act. We audited the number of capacity assessments on the general medical wards of an English-teaching hospital. A total of 95 sets of case notes were reviewed: the mean age was 78.6 years, 57 were female. The most (...) common presenting complaints were feeling ‘unwell’ (n = 25) and confusion (n = 24). In all, 52 patients had conditions, such as delirium (n = 26) and dementia (n = 15), which often impair capacity. Capacity was assessed in seven (7.4%) patients, all of whom disagreed with the medical team about their treatment. The number of documented assessments fell short of the estimated rate of incapacity, suggesting that some means of improving capacity assessment in busy medical environments is required. (shrink)

The Mental Capacity Act 2005 has put the assessment of mental capacity for decision-making at the forefront of psychiatric practice. This capacity is commonly linked within philosophy to autonomy, that is, to the idea, or ideal, of self-government. However, philosophers disagree deeply about what constitutes autonomy. This contribution brings out how the competing conceptions of autonomy would play out in psychiatric practice, taking anorexia nervosa as a test case. © 2009 Elsevier Ltd. All rights reserved.

Since 1998, several attempts have been made to reform the existing mental health legislation - the Mental Health Act 1983. However, all efforts thus far have been resoundingly rejected by mental health charities, psychiatrists and related professions. Following the Government's decision to abandon the draft Mental Health Bill in March 2006, plans to introduce new legislation designed to amend the existing 1983 Act have been published. This shorter bill was introduced before Parliament in November 2006. The (...) amendments focused on six key policy areas including supervised community treatment, the nearest relative, the definition of mental disorder and detention criteria. It is also intended that the Mental Capacity Act 2005 will be amended to bridge the present 'Bournewood' gap. (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)

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)

ABSTRACTLawyers play an important role in protecting the interests of the vulnerable in society. Increasingly those engaged in working with clients who are mentally ill, elderly, or experiencing fluctuating mental capacity, are called upon to make decisions and protect interests of clients who struggle to understand the legal consequence and meaning of their decisions. Ethical principles that prohibit lawyers acting on anything other than competent instructions, and disapprove of acting ‘in the best interests’ of clients in the absence (...) of competent instructions, create a series of philosophical and practical challenges to lawyers who work in this area. This article considers the evolution of ethical guidelines in Australia and the United States, noting the significant divergence in philosophy and practice within these jurisdictions. (shrink)

Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.

This is a response to Professor Fennell's paper on the recent influence and impact of the best interests test on the treatment of patients detained under the Mental Health Act 1983 (MHA) for mental disorder. I discuss two points of general ethical significance raised by Professor Fennell. Firstly, I consider his argument on the breadth of the best interests test, incorporating as it does factors considerably wider than those of medical justifications and the risk of harm. Secondly, I (...) discuss his contention that the apparent permeability of the line between the interests of the patient and the interests of society is something to be concerned about in itself. Since the overarching theme of the paper is the proper place of social and cultural values, my reponse considers the implications of Fennell's arguments in the light of Charlotte Brontë's novel ‘Jane Eyre’, which, through the character of Bertha Mason (the infamous ‘mad woman in the attic’) provides a provocative study of the relationship between mental disorder and society. (shrink)

Objectives: The mental health legislation of most developed countries includes either a dangerousness criterion or an obligatory dangerousness criterion (ODC). A dangerousness criterion holds that mentally ill people may be given treatment without consent if they are deemed to be a risk to themselves or others. An ODC holds that mentally ill people may be given treatment without consent only if they are deemed to be a risk to themselves or others. This paper argues that the dangerousness criterion is (...) unnecessary, unethical and, in the case of the ODC, potentially harmful to mentally ill people and to the rest of the community. Methods: We examine the history of the dangerousness criterion, and provide reasoned argument and empirical evidence in support of our position. Results: Dangerousness criteria are not required to balance the perceived loss of autonomy arising from mental health legislation. Dangerousness criteria unfairly discriminate against the mentally ill, as they represent an unreasonable barrier to treatment without consent, and they spread the burden of risk that any mentally ill person might become violent across large numbers of mentally ill people who will never become violent. Mental health legislation that includes an ODC is associated with a longer duration of untreated psychosis, and probably contributes to a poorer prognosis and an increase risk of suicide and violence in patients in their first episode of psychosis. Conclusions: Dangerousness criteria should be removed from mental health legislation and be replaced by criteria that focus on a patient’s capacity to refuse treatment. (shrink)

The notion of capacity implicit in the Mental Capacity Act is subject to a tension between two claims. On the one hand, capacity is assessed relative to a particular decision. It is the capacity to make one kind of judgement, specifically, rather than another. So one can have capacity in one area and not have it in another. On the other hand, capacity is supposed to be independent of the ‘wisdom’ or otherwise of (...) the decision made. (‘A person is not to be treated as unable to make a decision merely because he makes an unwise decision.’ Department of Constitutional Affairs 2005, section 1). One may have capacity even if the decision one arrives at is seen as unwise by one’s doctor. In this short note, I explore this .. (shrink)

It is usually appropriate for adults to make significant decisions, such as about what kinds of medical treatment to undergo, for themselves. But sometimes impairments are suffered - either temporary or permanent - which render an individual unable to make such decisions. The Mental Capacity Act 2005 sets out the conditions under which it is appropriate to regard an individual as lacking the capacity to make a particular decision (and when provisions should be made for a decision (...) on their behalf). -/- To what extent does having capacity require the endorsement of certain values? Drawing on Owens et al (2009), I assess the extent to which understanding relevant information and weighing it in coming to a decision requires certain evaluative commitments. With reference to literature on anorexia nervosa and decisions informed by religious beliefs, I argue that it is difficult to avoid the conclusion that the conditions for capacity are value-laden, and that if this is so it is important to open discussion about which patterns of distorted valuing undermine capacity, and why. (shrink)

A prominent but poorly understood domain of human agency is mental action, i.e., thecapacity for reaching specific desirable mental statesthrough an appropriate monitoring of one's own mentalprocesses. The present paper aims to define mentalacts, and to defend their explanatory role againsttwo objections. One is Gilbert Ryle's contention thatpostulating mental acts leads to an infinite regress.The other is a different although related difficulty,here called the access puzzle: How can the mindalready know how to act in order to reach (...) somepredefined result? A crucial element in the solutionof these puzzles consists in making explicit thecontingency between mental acts and mentaloperations, parallel to the contingency betweenphysical acts and bodily movements. The paper finallydiscusses the kind of reflexivity at stake in mentalacts; it is shown that the capacity to refer tooneself is not a necessary condition of the successfulexecution of mental acts. (shrink)

This book is a critical and analytical survey of the major attempts, in modern philosophy, to deal with the phenomenon of intentionality—those of Descartes, Brentano, Meinong, Husserl, Frege, Russell, Bergmann, Chisholm, and Sellars. By coordinating the semantical approaches to the phenomenon, Dr. Aquila undertakes to provide a basis for dialogue among philosophers of different persuasions. "Intentionality" has become, since Franz Brentano revived its original medieval use, the standard term describing the mind's apparently paradoxical capacity to relate itself to objects (...) existing in the world. One approach to the phenomenon emphasizes the mental act. The author argues that the most adequate account involves elements of both approaches. Contemporary treatments tend to formulate problems of intentionality primarily in terms of logic and semantics rather than those of metaphysics and phenomenology. Dr. Aquila's effort to coordinate these approaches will make his book useful to students both of analytical philosophy of mind and also of phenomenology. (shrink)

A prominent but poorly understood domain of human agency is mental action, i.e., thecapacity for reaching specific desirable mental statesthrough an appropriate monitoring of one's own mentalprocesses. The present paper aims to define mentalacts, and to defend their explanatory role againsttwo objections. One is Gilbert Ryle's contention thatpostulating mental acts leads to an infinite regress.The other is a different although related difficulty,here called the access puzzle: How can the mindalready know how to act in order to reach (...) somepredefined result? A crucial element in the solutionof these puzzles consists in making explicit thecontingency between mental acts and mentaloperations, parallel to the contingency betweenphysical acts and bodily movements. The paper finallydiscusses the kind of reflexivity at stake in mentalacts; it is shown that the capacity to refer tooneself is not a necessary condition of the successfulexecution of mental acts. (shrink)

This chapter examines the mechanistic psychology of Descartes in the _Passions_, while also drawing on the _Treatise on Man_. It develops the idea of a Cartesian “psychology” that relies on purely bodily mechanisms by showing that he explained some behaviorally appropriate responses through bodily mechanisms alone and that he envisioned the tailoring of such responses to environmental circumstances through a purely corporeal “memory.” An animal’s adjustment of behavior as caused by recurring patterns of sensory stimulation falls under the notion of (...) “learning,” behavioristically conceived. Indeed, Descartes’s animal-machine hypothesis may well be a distant ancestor to Watsonian behaviorism, via T. H. Huxley (1884). The final two sections of the chapter take stock of what psychological capacities Descartes ascribed to mind, body, or both, and consider those capacities that we might now plausibly construe as being explicable by nonmentalistic mechanisms as opposed to those that at present remain unreducedly mentalistic. -/- This chapter derives from a lecture delivered at the University of King's College (Halifax, Nova Scotia) as part of a year-long series on Descartes and the Modern. The lecture series was co-sponsored by the programs in History of Science and Early Modern and Contemporary Studies. (shrink)

An effective demonstration that the techniques of Oxford analysis can be put to constructive as well as to critical philosophic use. Mr. Geach considers a number of connected topics--among them the nature and formation of concepts, judgment, and sensation--advancing positive theses while rejecting views he holds to be false. He is particularly opposed to the "abstractionist" doctrine of concept formation. Concepts, he holds, are not capacities for recognizing recurrent features in experience, but "mental abilities, exercised in acts of judgment, (...) and expressed in the intelligent use of words," though not, he adds, "exclusively in such use." Despite the connections among the topics dealt with, the book remains somewhat episodic, and many of its points are sketched or suggested only, rather than fully developed. But Mr. Geach's arguments are elegant, and what is worked out is compelling. One curious feature of the book is its frequent citation of St. Thomas Aquinas--Mr. Geach seems as anxious to be on the side of the Angelic Doctor as he is to be in tune with Wittgenstein.--V. C. C. (shrink)

Mental time travel is defined as projecting the self into the past and the future. Despite growing evidence of the similarities of remembering past and imagining future events, dominant theories conceive of these as distinct capacities. I propose that memory and imagination are fundamentally the same process – constructive episodic simulation – and demonstrate that the ‘simulation system’ meets the three criteria of a neurocognitive system. Irrespective of whether one is remembering or imagining, the simulation system: acts on the (...) same information, drawing on elements of experience ranging from fine-grained perceptual details to coarser-grained conceptual information and schemas about the world; is governed by the same rules of operation, including associative processes that facilitate construction of a schematic scaffold, the event representation itself, and the dynamic interplay between the two ; and is subserved by the same brain system. I also propose that by forming associations between schemas, the simulation system constructs multi-dimensional cognitive spaces, within which any given simulation is mapped by the hippocampus. Finally, I suggest that simulation is a general capacity that underpins other domains of cognition, such as the perception of ongoing experience. This proposal has some important implications for the construct of ‘MTT’, suggesting that ‘time’ and ‘travel’ may not be defining, or even essential, features. Rather, it is the ‘mental’ rendering of experience that is the most fundamental function of this domain-general simulation system enabling humans to re-experience the past, pre-experience the future, and also comprehend the complexities of the present. (shrink)

This book draws on both the historical context & contemporary research evidence to present the roles of mental health social work, AMHP & BIA, within an ethical framework. Codes of practice & statutory legal requirements, such as the Mental Health Act, Mental Capacity Act & the Human Rights Act, are all considered.

In this paper I will examine how the Mental Capacity Act 2005 regulates the assessment of decision-making capacity in England and Wales. I will argue that there are difficulties in reconciling the Act with how people make decisions in practice. I will explore how ideas from the ethics of care and from phenomenology can be used to take better account of how capacity flows from a person's relationships as well as their individual abilities. I will conclude (...) by discussing some of the ethical issues that have arisen in my assessments of decision-making capacity and how I have tried to respond. (shrink)