Is decision-making capacity an “essentially contested” concept in pediatrics?

Med Health Care and Philos (2017). doi:10.1007/s11019-017-9768-z
Authors: Eva De Clercq, Katharina Ruhe, Michel Rost, Bernice Elger
“Key legislations in many countries emphasize the importance of involving children in decisions regarding their own health at a level commensurate with their age and capacities. Research is engaged in developing tools to assess capacity in children in order to facilitate their responsible involvement. These instruments, however, are usually based on the cognitive criteria for capacity assessment as defined by Appelbaum and Grisso and thus ill adapted to address the life-situation of children. The aim of this paper is to revisit and critically reflect upon the current definitions of decision-making capacity.”
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Presumed consent: licenses and limits inferred from the case of geriatric hip fractures

BMC Medical Ethics 2017 18:17
Authors: Joseph Bernstein, Drake LeBrun, Duncan MacCourt, Jaimo Ahn
“Hip fractures are common and serious injuries in the geriatric population. Obtaining informed consent for surgery in geriatric patients can be difficult due to the high prevalence of comorbid cognitive impairment. Given that virtually all patients with hip fractures eventually undergo surgery, and given that delays in surgery are associated with increased mortality, we argue that there are select instances in which it may be ethically permissible, and indeed clinically preferable, to initiate surgical treatment in cognitively impaired patients under the doctrine of presumed consent.”
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Decision-making on behalf of people living with dementia: how do surrogate decision-makers

J Med Ethics 2017;43:35-40
Authors: Deirdre Fetherstonhaugh, Linda McAuliffe, Michael Bauer, Chris Shanley
“For people living with dementia, the capacity to make important decisions about themselves diminishes as their condition advances. As a result, important decisions (affecting lifestyle, medical treatment and end of life) become the responsibility of someone else, as the surrogate decision-maker. This study investigated how surrogate decision-makers make important decisions on behalf of a person living with dementia.”
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Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders

BMC Health Services Research 2016 16:656
Authors: Anne Opsal, Øistein Kristensen, John Kåre Vederhus, Thomas Clausen
“Perceived coercion is a sense of pressure related to the experience of being referred to treatment. The sense of pressure arises from the patient’s internal perception of coercion. The sources of coercion may be the legal system, the family, the health system, or self-criticism (internal sources). Here, we studied patients diagnosed with substance use disorders that were involuntarily admitted to hospital, pursuant to a social services act. We sought to determine whether these patients perceived coercion differently than patients that were admitted voluntarily.”
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Next of kin’s experiences of involvement during involuntary hospitalisation and coercion

BMC Medical Ethics 2016 17:76
Authors: Reidun Førde, Reidun Norvoll, Marit Helene Hem, Reidar Pedersen
“Norway has extensive and detailed legal requirements and guidelines concerning involvement of next of kin (NOK) during involuntary hospital treatment of seriously mentally ill patients. However, we have little knowledge about what happens in practice. This study explores NOK’s views and experiences of involvement during involuntary hospitalisation in Norway.”
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Mental capacity of those in immigration detention in the UK

Med Sci Law October 2016 vol. 56 no. 4 285-292
Authors: Hugh Grant-Peterkin, Hilary Pickles, Cornelius Katona
“Asylum seekers and migrants can be detained in immigration removal centres (IRCs) or, post sentence, in prison while the Home Office makes decisions on their immigration status and/or arrangements for their removal or deportation. Currently, there is no process for identifying detainees who lack the mental capacity to participate in decision making relating to their immigration situation. Mental illness and distress are common among detainees. There are often cultural and language barriers; there is no consistent system of advocates, and many detainees are without legal representation.”
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Research involving adults lacking capacity to consent: the impact of research regulation on ‘evidence biased’ medicine

BMC Medical Ethics BMC series – open, inclusive and trusted 2016 17:55
Author: Victoria Shepherd
“Society is failing in its moral obligation to improve the standard of healthcare provided to vulnerable populations, such as people who lack decision making capacity, by a misguided paternalism that seeks to protect them by excluding them from medical research. Uncertainties surround the basis on which decisions about research participation is made under dual regulatory regimes, which adds further complexity. Vulnerable individuals’ exclusion from research as a result of such regulation risks condemning such populations to poor quality care as a result of ‘evidence biased’ medicine.”
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Consultation package: preconditions for alternative decision making

NSW Law Reform Commission
“On 22 August 2016 we released Question Paper 1: Preconditions for alternative decision-making arrangements. This Question Paper considers the circumstances that must exist before a decision-maker can be appointed under the system of guardianship in NSW to make personal, financial and medical decisions for somebody else. We seek your views about these preconditions. Submission close on Monday 17 October 2016.”
Find paper here.

Background Paper: Review of the Guardianship Act 1987

NSW Law Reform Commission, news 12 July 2016
“On 30 June 2016 we released Background Paper: Review of the Guardianship Act 1987. …The Background Paper is the first in a series of papers that we will be releasing and provides an overview of guardianship law in NSW. …We have also created a survey which corresponds with the Background Paper. The survey is a way to express your opinions about guardianship arrangements in NSW without making a formal submission.”
Find paper and survey here.