Decision-making capacity in clinical and research settings

临床和研究环境中的决策能力

基本信息

批准号：
10684568
负责人：
Scott Kim
金额：
--
依托单位：
CLINICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
资助国家：
美国
起止时间：
至
项目状态：
未结题

项目摘要

1. We completed our analysis of how the courts (judges and expert consultants to the court) interpreted the decision making criteria in the Mental Capacity Act. We analyzed 131 Court of Protection cases and created a typology of "capacity rationales" that appeared to underlie the judgments of the judges/experts. This typology has 9 rationales (with two having subcategories, so that total categories = 13). We further found associations between these rationales with the MCA criteria and the various disorders that form the basis for incapacity. This paper was published in PLOS ONE (see biblio). We then conducted a follow up 'critical normative analysis' to outline how to optimize the application of the DMC criteria using the insights gained from this study. This was published in Journal of Medical Ethics. 2. We are continuing to analyze interviews with judges, lawyers, and psychiatrists regarding their views of the practice of capacity assessments under the MCA in England/Wales, especially regarding what each discipline considers "difficult cases." We completed our first analysis, focusing on the challenging cases as described by experienced consultation psychiatrists. 3. One of the most persistent debates in bioethics and law regarding decision-making capacity is whether the threshold for having capacity should be sensitive to risk. Many see this as intuitive and obvious. Others see it as dangerously paternalistic. We conducted a systematic literature review of this debate over risk sensitive DMC. Using the review, we are developing a comprehensive defense of RS DMC, addressing all of the key objections against it.

1. 我们完成了对法院（法官和法院专家顾问）如何解释《心智能力法》中的决策标准的分析。我们分析了 131 个保护法院案件，并创建了“能力理由”类型，这似乎是法官/专家判决的基础。这种类型有 9 个基本原理（其中两个有子类别，因此总类别 = 13）。我们进一步发现这些基本原理与 MCA 标准以及构成丧失能力基础的各种疾病之间的关联。这篇论文发表在 PLOS ONE 上（参见 biblio）。然后，我们进行了后续“关键规范分析”，概述了如何利用从本研究中获得的见解来优化 DMC 标准的应用。该文章发表在《医学伦理学杂志》上。 2. 我们正在继续分析对法官、律师和精神病学家的访谈，了解他们对英格兰/威尔士 MCA 能力评估实践的看法，特别是关于每个学科认为“疑难案件”的观点。我们完成了第一次分析，重点关注经验丰富的咨询精神病学家所描述的具有挑战性的案例。 3. 生物伦理学和法律界关于决策能力最持久的争论之一是拥有能力的门槛是否应该对风险敏感。许多人认为这是直观且显而易见的。其他人则认为这是危险的家长作风。我们对这场关于风险敏感 DMC 的争论进行了系统的文献综述。通过审查，我们正在制定 RS DMC 的全面辩护，解决针对它的所有主要反对意见。