The COVID-19 vaccine and the best interests of a person who lacks capacity

2021 ◽  
Vol 30 (5) ◽  
pp. 320-321
Author(s):  
Richard Griffith

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers two recent cases in the Court of Protection that determined if the COVID-19 vaccine was in the best interests of a person who lacked the mental capacity to decide on immunisation after relatives objected its administration

2021 ◽  
Vol 30 (3) ◽  
pp. 196-197
Author(s):  
Richard Griffith

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses recent cases from the Court of Protection that have focused on a person's mental capacity to engage safely with social media


Author(s):  
Katherine Reidy ◽  
Brendan D. Kelly

Although significant progress has been made in Irish mental health law in recent decades, the Mental Health Act, 2001 still falls short of properly protecting human rights. A consideration of human rights developments, both domestically and internationally, highlights the urgent need for reform. In this paper we consider Sections 4 (‘Best interests’), 3 (‘Mental disorder’) and 57 (‘Treatment not requiring consent’) of the 2001 Act and related recommendations in the 2015 Report of the Expert Group on the Review of the Mental Health Act, 2001, and suggest specific areas for reform. Just as medicine evolves over time, so too does our understanding of human rights and law. While embracing a human rights-based approach to the extent suggested here might be seen as aspirational, it is important to balance achievable goals with higher ideals if progress is to be made and rights are to be respected.


2021 ◽  
Vol 30 (7) ◽  
pp. 446-447
Author(s):  
Richard Griffith

In the first of a series of articles Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the fundamental nature of human rights and their importance to nursing


2020 ◽  
Vol 29 (21) ◽  
pp. 1296-1297
Author(s):  
Richard Griffith

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the role of the nearest relative, a statutory friend, appointed for patients detained under the Mental Health Act 1983


2021 ◽  
Vol 30 (21) ◽  
pp. 1258-1259
Author(s):  
Richard Griffith

Richard Griffith, Senior Lecturer in Health Law at Swansea University, discusses the implications of a Court of Appeal decision that considers the scope of the Sexual Offences Act 2003, section 39, in relation to care workers


2018 ◽  
Vol 45 (1) ◽  
pp. 3-7 ◽  
Author(s):  
Charles Foster

Over the last quarter of a century, English medical law has taken an increasingly firm stand against medical paternalism. This is exemplified by cases such as Bolitho v City and Hackney Health Authority, Chester v Afshar, and Montgomery v Lanarkshire Health Board. In relation to decision-making on behalf of incapacitous adults, the actuating principle of the Mental Capacity Act 2005 is respect for patient autonomy. The only lawful acts in relation to an incapacitous person are acts which are in the best interests of that person. The 2005 Act requires a holistic assessment of best interests. Best interests are wider than ‘medical best interests’. The 2018 judgment of the Supreme Court in An NHS Trust v Y (which concerned the question of whether a court needed to authorise the withdrawal of life-sustaining clinically administered nutrition/hydration (CANH) from patients in prolonged disorders of consciousness (PDOC)) risks reviving medical paternalism. The judgment, in its uncritical endorsement of guidelines from various medical organisations, may lend inappropriate authority to medical judgments of best interests and silence or render impotent non-medical contributions to the debate about best interests—so frustrating the 2005 Act. To minimise these dangers, a system of meditation should be instituted whenever it is proposed to withdraw (at least) life-sustaining CANH from (at least) patients with PDOC, and there needs to be a guarantee of access to the courts for families, carers and others who wish to challenge medical conclusions about withdrawal. This would entail proper public funding for such challenges.


2018 ◽  
Vol 86 (3) ◽  
pp. 142-146
Author(s):  
Emma M Szelepet

The Mental Capacity Act 2005 (‘MCA’) sets out a regime which governs the making of decisions for people who lack mental capacity. Acts must be carried out, and decisions made, for such an incapacitated person, based on what is in her best interests (section 4 MCA). In this paper, I consider the body of post-MCA case law which applies the MCA best interests test to decision-making for elderly people, in various contexts. Is the best interests test ‘fit for purpose’ for the vulnerable elderly? The key aims of Parliament in introducing the test seem to have been empowerment, protection and support – and alertness to undue influence – as well as a balance between the objective and subjective viewpoints. Laudable attempts have been made by some judges, applying the MCA, to pay real heed to the patient's wishes and values, and to balance physical risk with welfare and happiness. However, it is not yet clear in my view that the new regime fully achieves Parliament’s aims. Indeed, these aims themselves should be expanded; the law in this area should also promote the significance and value of advanced years and should recognise Aristotle's concept of ‘human flourishing’ in old age. Consideration should be given to amending the MCA, adding guidance specifically for the elderly and also to introducing a Convention of Human Rights for the older person and to creating a new statutory Older Persons’ Commissioner and/or a cabinet-level Minister for Ageing and Older People.


2020 ◽  
Vol 29 (19) ◽  
pp. 1136-1137
Author(s):  
Richard Griffith

Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers cases that highlight the consequences for nurses and their employer of failing to discharge their professional and statutory duty of candour


2020 ◽  
Vol 11 ◽  
Author(s):  
Andrew McWilliams ◽  
Stephen M. Fleming ◽  
Anthony S. David ◽  
Gareth Owen

The 2005 Mental Capacity Act of England and Wales provides a description in statute law of a test determining if a person lacks “mental capacity” to take a particular decision and describes how the “best interests” of such a person should be determined. The Act established a new Court of Protection (CoP) to hear cases related to the Act and to rule on disputes over mental capacity. The court gathers a range of evidence, including reports from clinicians and experts. Human rights organisations and others have raised concerns about the nature of assessments for incapacity, including the role of brain investigations and psychometric tests.Aim: Describe use and interpretation of structured measures of psychological and brain function in CoP cases, to facilitate standardisation and improvement of practices, both in the courtroom and in non-legal settings.Method: Quantitative review of case law using all CoP judgments published until 2019. The judgments (n = 408) were read to generate a subset referring to structured testing (n = 50). These were then examined in detail to extract the nature of the measurements, circumstances of their use and features of interpretation by the court.Results: The 408 judgments contained 146 references to structured measurement of psychological or brain function, spread over 50 cases. 120/146 (82.2%) referred to “impairment of mind or brain,” with this being part of assessment for incapacity in 58/146 (39.7%). Measurement referred on 25/146 (17.1%) occasions to “functional decision-making abilities.” Structured measures were used most commonly by psychiatrists and psychologists. Psychological measurements comprised 66.4% of measures. Neuroimaging and electrophysiology were presented for diagnostic purposes only. A small number of behavioural measures were used for people with disorders of consciousness. When assessing incapacity, IQ and the Mini-Mental-State Examination were the commonest measures. A standardised measure of mental capacity itself was employed just once. Judges rarely integrated measurements in their capacity determinations.Conclusion: Structured testing of brain and psychological function is used in limited ways in the Court of Protection. Whilst there are challenges in creating measures of capacity, we highlight an opportunity for the neuroscience community to improve objectivity in assessment, inside and outside the courtroom.


Author(s):  
Kay Wilson

The debate about whether mental health law should be abolished or reformed emerged during the negotiations of the Convention on the Right of Persons with Disabilities (‘CRPD’) and has raged fiercely for over a decade. It has resulted in an impasse between abolitionists, States Parties, and other reformers and a literature which has devolved into ‘camps’. Mental Health Law: Abolish or Reform? aims to cut through the confusion using the tools of human rights treaty interpretation backed by a deep jurisprudential analysis of core CRPD concepts—dignity (including autonomy), equality, and participation—to gain a clearer understanding of the meaning of the CRPD and what it requires States Parties to do. In doing so, it sets out the development of both mental health law and the abolitionist movement including its goals and how and why it has emerged now. By digging deeper into the conceptual basis of the CRPD and developing the ‘interpretive compass’, the book aims to flesh out a broader vision of disability rights and move the debate forward by evaluating the three main current abolition and reform options: Abolition with Support, Mental Capacity with Support, and Support Except Where There is Harm. Drawing on jurisprudential and multi-disciplinary research from philosophy, medicine, sociology, disability studies, and history, it argues that mental health law should not be abolished, but should instead be significantly reformed to minimize coercion and maximize the support and choices given to persons with mental impairments to realize of all of their CRPD rights.


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