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1.
Pediatrics ; 146(Suppl 1): S18-S24, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32737228

RESUMO

With a few notable exceptions, adolescents do not possess the legal authority to provide consent for or refuse medical interventions. However, in some situations, the question arises regarding whether a mature minor should be permitted to make a life-altering medical decision that would be challenged if made by the minor's parent. In this article, I explore what we currently know about the adolescent brain and how that knowledge should frame our understanding of adolescent decision-making. The prevailing approach to determining when adolescents should have their decisions respected in the medical and legal context, an approach that is focused on establishing capacity under a traditional informed consent model, will be reviewed and critiqued. I will suggest that the traditional model is insufficient and explore the implications for the adolescent role in health care decision-making.


Assuntos
Desenvolvimento do Adolescente , Encéfalo/crescimento & desenvolvimento , Tomada de Decisão Clínica , Doença de Hodgkin/tratamento farmacológico , Consentimento Livre e Esclarecido/psicologia , Recusa do Paciente ao Tratamento/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Fatores Etários , Feminino , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Mães , Patient Self-Determination Act , Autonomia Pessoal , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Estados Unidos
2.
S Afr Fam Pract (2004) ; 62(1): e1-e4, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32787389

RESUMO

Medical practitioners are confronted daily with decisions about patients' capacity to consent to interventions. To address some of the pertinent issues with these assessments, the end-of-life decision-making capacity of a 72-year-old female with treatment-resistant schizophrenia and terminal cancer is discussed, as are the role of the treating clinician and the importance of health-related values. There is a recommendation that the focus of these assessments can rather be on practical outcomes, especially when capacity issues arise. This implies that the decision-making capacity of the patient is only practically important when the treatment team is willing to proceed against the patient's wishes. This shifts the focus from a potentially difficult assessment to the simpler question of whether the patient's capacity will change the treatment approach. Clinicians should attend to any possible underlying issues, instead of focusing strictly on capacity. Compared to the general populations people with serious mental illness (SMI) have higher rates of physical illness and die at a younger age, but they do not commonly access palliative care services. Conversations about end-of-life care can occur without fear that a person's psychiatric symptoms or related vulnerabilities will undermine the process. More research about palliative care and advance care planning for people with SMI is needed. This is even more urgent in light of the coronavirus disease-2019 (COVID-19) pandemic, and South African health services should consider recommendations that advanced care planning should be routinely implemented. These recommendations should not only focus on the general population and should include patients with SMI.


Assuntos
Tomada de Decisões , Competência Mental/psicologia , Neoplasias/psicologia , Psicologia do Esquizofrênico , Assistência Terminal/psicologia , Idoso , Betacoronavirus , Infecções por Coronavirus/psicologia , Feminino , Humanos , Consentimento Livre e Esclarecido/psicologia , Pandemias , Pneumonia Viral/psicologia , Esquizofrenia
3.
Int J Law Psychiatry ; 70: 101560, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32482298

RESUMO

In the course of a few short weeks, many of the established legal frameworks relating to decision-making in England & Wales in respect of those with impaired decision-making capacity have been ripped up, or apparently rendered all but unusable. Although the Mental Capacity Act 2005 itself has not been amended, the impact of other legislation (especially the Coronavirus Act 2020) means that duties towards those with impaired decision-making capacity have been radically changed. This article reflects the experience of a practising barrister in England & Wales grappling with the impact of COVID-19 upon the Mental Capacity Act 2005 across a range of fields in the weeks after the world appeared to change in mid-March 2020.


Assuntos
Infecções por Coronavirus/psicologia , Tomada de Decisões , Competência Mental/psicologia , Pneumonia Viral/psicologia , Betacoronavirus , Infecções por Coronavirus/terapia , Inglaterra , Direitos Humanos/psicologia , Humanos , Competência Mental/legislação & jurisprudência , Pandemias , Pneumonia Viral/terapia , Saúde Pública , Medicina Estatal , País de Gales
4.
Hastings Cent Rep ; 50(3): 16-17, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596895

RESUMO

Mrs. Clark's case was an ordinary consult in an extraordinary time. She was refusing dialysis, but the psychiatric unit had concluded that she lacked capacity for such decision-making. The only difference between Mrs. Clark's current hospitalization and the last two was that it was April 2020 and a virus called Covid-19 had overtaken our hospital. As the chief of Montefiore Medical Center's bioethics service, when I received a consult before the virus, I always saw the patient. Whether the patient had been in a vegetative state for a day or for years, it didn't matter. I would lay my hand on a leg or an arm and observe. But Covid-19 enforced physical boundaries between my team and our patients; I would not be able to meet Mrs. Clark. Our hospital responded to the attack on human connection by getting creative. We asked ourselves, which tools are still available to us? Answering this involved, in part, finding new ways for our team of clinical ethicists to support the clinicians caring for Mrs. Clark.


Assuntos
Temas Bioéticos , Infecções por Coronavirus/epidemiologia , Competência Mental/psicologia , Transtornos Mentais/psicologia , Pneumonia Viral/epidemiologia , Mídias Sociais , Betacoronavirus , Consultoria Ética , Humanos , Pandemias , Diálise Renal/ética , Diálise Renal/métodos , Insuficiência Renal Crônica/terapia
5.
Emerg Med Clin North Am ; 38(2): 283-296, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336325

RESUMO

This article focuses on confidentiality and capacity issues affecting patients receiving care in the emergency department. The patient-physician relationship begins with presumed confidentiality. The article also clarifies instances where a physician may be required to break confidentiality for the safety of patients or others. This article then discusses risk management issues relevant to determining a patient's capacity to accept or decline medical care in the emergency department setting. Situations pertaining to refusal of care and discharges against medical advice are examined in detail, and best practices for mitigating risk in informed consent and barriers to consent are reviewed.


Assuntos
Confidencialidade , Competência Mental , Confidencialidade/ética , Confidencialidade/legislação & jurisprudência , Confidencialidade/psicologia , Medicina de Emergência/ética , Medicina de Emergência/legislação & jurisprudência , Health Insurance Portability and Accountability Act , Humanos , Competência Mental/psicologia , Estados Unidos
6.
Infant Behav Dev ; 59: 101443, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32276086

RESUMO

The study of early parental competences is relevant because such competences are related to children's development; however, most studies have considered competences using a variable-centered approach in which each parental competence is examined in isolation. This paper approaches these competences using a person-centered approach, generating profiles that combine different competences in Chilean mothers assessed when their children were aged 12 months and again at 30 months. The aim of this study was to generate and compare these profiles and to analyze the associations of these profiles with children's language and socioemotional skills. Mother-child interactions in the contexts of storytelling and free play were videotaped at two different times. Ninety mother-child dyads were assessed using the Adult Sensitivity Scale (E.S.A.), the Evaluation of the Mentalization of Significant Caregivers, the Checklist of Observations Linked to Outcomes (PICCOLO), Bayley's language scale and the Functional Emotional Assessment Scale (FEAS). Profiles of mothers' behaviors were identified through person-centered within-group analyses of six aspects: sensitivity, mentalization, affection, responsiveness, encouragement, and teaching. Cluster analyses yielded three similar profiles for mothers at both ages: highly competent, average competent, and poorly competent. The mothers' profiles were related to maternal age, socioeconomic status (SES) and educational level, and the mothers improved their profiles at the 30-month assessment. The mothers' profiles were related to children's language and socioemotional outcomes at both ages. These results and their applicability to promotion and intervention programs are discussed.


Assuntos
Linguagem Infantil , Emoções , Relações Interpessoais , Comportamento Materno/psicologia , Competência Mental/psicologia , Relações Mãe-Filho/psicologia , Adulto , Pré-Escolar , Chile/epidemiologia , Emoções/fisiologia , Feminino , Humanos , Lactente , Masculino , Comportamento Materno/fisiologia , Mães/psicologia
7.
J Clin Nurs ; 29(7-8): 1254-1266, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31951067

RESUMO

AIMS: To explore processes used by qualified nurses in assessing mental capacity of acutely and critically ill hospitalised adult patients. BACKGROUND: Mental capacity is the ability to understand, reason and make decisions. Acute and critical illness may impact upon the decision-making abilities of hospitalised adult patients but little is known about how qualified nurses across a range of acute settings assess the capacity of such patients in their care. DESIGN: A qualitative grounded theory approach informed by the Corbin and Strauss (Basics of Qualitative Research (Third Edition). London, UK: Sage, 2008) methodological pathway. METHODS: Data were collected through digitally recorded, semi-structured interviews to explore assessment of capacity processes used by 13 registered nurses employed in acute and critical care environments in a district general hospital in South Wales, UK. Data were analysed using iterative constant comparative processes leading to a core category and grounded theory. The study is presented in accordance with the COREQ checklist. RESULTS: Informal, intuitive, holistic nurse-led processes were used to assess the mental capacity of patients which combined processes for the assessment of their physiological and mental capacity status, recognising the need to support their rights, dignity and autonomy. The assessment of mental capacity was not a lone process but one that contributed to a cyclical process in which multi-professional assessment was necessary and ongoing, and in which qualified nurses had a co-ordinating role. This led to the development of the theory, Nurse Managed Patient Focused Assessment and Care. CONCLUSION: This theory provides a framework to explain processes and strategies used by qualified nurses in assessing mental capacity of, and caring for, adult patients with acute and/or critical illness. RELEVANCE TO CLINICAL PRACTICE: This framework may inform related clinical practice and can serve as a basis of an assessment tool in what has been identified as a fundamental role of the qualified nurse.


Assuntos
Enfermagem de Cuidados Críticos/métodos , Competência Mental/psicologia , Papel do Profissional de Enfermagem , Adulto , Estado Terminal/psicologia , Tomada de Decisões , Feminino , Teoria Fundamentada , Humanos , Masculino , Relações Enfermeiro-Paciente , Pesquisa Qualitativa
8.
J Autism Dev Disord ; 50(5): 1509-1519, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30056502

RESUMO

Research suggests that autistic children can provide accurate and forensically useful eyewitness evidence. However, members of a jury also rely on non-verbal behaviours when judging the credibility of a witness, and this could determine the verdict of a case. We presented mock jurors with videos (from an experimental study) of one of two child witnesses on the autism spectrum being interviewed about a mock minor crime. Results demonstrated that providing jurors with generic information about autism and/or informing them of the child's diagnostic label differentially affected credibility ratings, but not for both children. Implications for how to present information about child witnesses with autism to a jury-highlighting the need for approaches tailored to individual children-are discussed.


Assuntos
Transtorno do Espectro Autista/psicologia , Crime/psicologia , Direito Penal/métodos , Função Jurisdicional , Competência Mental/psicologia , Adolescente , Adulto , Idoso , Criança , Tomada de Decisões , Feminino , Humanos , Julgamento , Masculino , Pessoa de Meia-Idade , Percepção , Adulto Jovem
9.
Psychooncology ; 29(2): 406-412, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31702844

RESUMO

OBJECTIVE: To determine if cognition can be used to identify persons with cancer at high risk for the impaired ability to understand treatment decisions. METHODS: The association between understanding treatment decisions and cognition was examined using data from 181 participants across four groups: 67 with brain metastasis, 41 with metastatic cancer that has not spread to the brain, 27 with malignant glioma, and 46 healthy controls. All diagnoses were made by board-certified oncologists and were verified histologically. RESULTS: Results indicated that numerous cognitive functions were associated with the ability to understand treatment decisions in persons with cancer. The following proportion of participants demonstrated impaired understanding of treatment decisions in our three patient groups: approximately 51% malignant glioma, approximately 46% brain metastasis, and approximately 24% metastatic cancer. In a combined brain cancer group, we were able to use cognitive performance to predict the impaired ability to understand treatment decisions. CONCLUSIONS: An impaired ability to understand treatment decisions is prevalent in persons with brain cancer and persons with metastatic cancer. Performance on a brief cognitive battery can be used to help clinicians identify patients at particular risk for impaired medical decision making.


Assuntos
Neoplasias Encefálicas/psicologia , Transtornos Cognitivos/psicologia , Cognição , Tomada de Decisões , Competência Mental/psicologia , Adulto , Neoplasias Encefálicas/complicações , Tomada de Decisão Clínica , Transtornos Cognitivos/etiologia , Feminino , Glioma/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/psicologia
10.
J Child Adolesc Ment Health ; 31(3): 224-234, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31805837

RESUMO

Considering the numbers of children and adolescents in conflict with the law, there is a concern about the ways in which they are being dealt with in the criminal justice system. This paper examines issues relating to the minimum age of criminal responsibility, the differences across countries, and the broad principles and international guidelines in this regard. Additionally, the rebuttable presumption of doli incapax, which is included in many legal systems, is discussed. This is done specifically with concerns regarding the psychological evaluation of criminal capacity, considering the lack of valid and reliable measures, as well as the vagueness of the concept of criminal capacity. An examination of the neurodevelopment evidence in relation to children's criminal behaviour, risk taking, and impulse control are discussed. The latest research evidence raises doubt about the extent to which adolescents can be held criminally responsible. The responsibility of expert witnesses to enlighten courts on this matter is crucial to avoid unnecessarily criminalising children and adolescents who may not have the requisite capacity to be held criminally liable.


Assuntos
Desenvolvimento Infantil , Direito Penal/legislação & jurisprudência , Competência Mental/legislação & jurisprudência , Adolescente , Desenvolvimento do Adolescente , Fatores Etários , Encéfalo/crescimento & desenvolvimento , Criança , Humanos , Competência Mental/psicologia
11.
J Bioeth Inq ; 16(4): 587-608, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31832863

RESUMO

Supported decision-making has been promoted at a policy level and within international human rights treaties as a way of ensuring that people with disabilities enjoy the right to legal capacity on an equal basis with others. However, little is known about the practical issues associated with implementing supported decision-making, particularly in the context of dementia. This study aimed to understand the experiences of people with dementia and their family members with respect to decision-making and their views on supported decision-making. Thirty-six interviews (twenty-one dyadic and fifteen individual) were undertaken with fifty-seven participants (twenty-five people living with dementia and thirty-two family members) across three states in Australia. Interpretative Phenomenological Analysis (IPA) was used as the methodological approach, with relational autonomy as a theoretical perspective. We identified two overarching themes relating to participants' experiences with decision-making: "the person in relationship over time" and "maintaining involvement." Participant views on the practical issues associated with supported decision-making are addressed under the themes of "facilitating decision-making," "supported decision-making arrangements," "constraints on decision-making," and "safeguarding decision-making." While participants endorsed the principles of supported decision-making as part of their overarching strategy of "maintaining involvement" in decision-making, they recognized that progressive cognitive impairment meant that there was an inevitable transition toward greater involvement of, and reliance upon, others in decision-making. Social and contextual "constraints on decision-making" also impacted on the ability of people with dementia to maintain involvement. These themes inform our proposal for a "spectrum approach" to decision-making involvement among people living with dementia, along with recommendations for policy and practice to assist in the implementation of supported decision-making within this population.


Assuntos
Tomada de Decisões , Demência/psicologia , Família/psicologia , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Entrevistas como Assunto , Masculino , Competência Mental/psicologia , Pessoa de Meia-Idade , Procurador/psicologia , Fatores de Tempo
12.
BMC Public Health ; 19(1): 1461, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694593

RESUMO

BACKGROUND: Positive mental health may support healthy development in childhood, although few studies have investigated this at a population level. We aimed to construct a measure of mental health competence (MHC), a skills-based assessment of positive mental health, using existing survey items in a representative sample of UK children, and to investigate its overlap with mental health difficulties (MHD), socio-demographic patterning, and relationships with physical health and cognitive development. METHODS: We analysed the UK Millennium Cohort Study (MCS) when children were aged 11 years. Maternal (n = 12,082) and teacher (n = 6739) reports of prosocial behaviours (PS) and learning skills (LS) were entered into latent class models to create MHC measures. Using descriptive statistics, we examined relationships between MHC and MHD, and the socio-demographic patterning of MHC. Associations between MHC and physical health and cognitive development were examined with relative risk ratios [RRR] (from multinomial models): BMI status (healthy weight, overweight, obesity); unintentional injuries since age 7 (none, 1, 2+); asthma symptoms (none, 1, 2+); and tertiles of test scores for verbal ability, spatial working memory and risk-taking. Models were adjusted for potential confounding. RESULTS: Four MHC classes were identified [percentages for maternal and teacher reports, respectively]: high MHC (high PS, high LS) [37%; 39%], high-moderate MHC (high PS, moderate LS) [36%; 26%]; moderate MHC (moderate PS, moderate LS) [19%; 19%]; low MHC (moderate PS, low LS) [8%; 16%]. Higher MHC was less common in socially disadvantaged children. While MHC and MHD were associated, there was sufficient separation to indicate that MHC captures more than the absence of MHD. Compared to children with high MHC, those in other MHC classes tended to have poorer physical health and cognitive development, particularly those with low MHC or high-moderate MHC. For example, children with maternal-report Low MHC were more likely to have experienced 2+ unintentional injuries (RRR: 1.5 [1.1-2.1]) and to have lower verbal ability scores (RRR: 2.5 [1.9-3.2]). Patterns of results were similar for maternal- and teacher-report MHC. CONCLUSION: MHC is not simply the inverse of MHD, and high MHC is associated with better physical health and cognitive development. Findings suggest that interventions to improve MHC may support healthy development, although they require replication.


Assuntos
Nível de Saúde , Competência Mental/psicologia , Saúde Mental , Criança , Desenvolvimento Infantil , Cognição , Estudos de Coortes , Demografia , Feminino , Humanos , Masculino , Reino Unido/epidemiologia
13.
Int J Law Psychiatry ; 66: 101469, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706384

RESUMO

The relationship between age and mental capacity among psychiatry inpatients is not fully understood. We aimed to assess mental capacity for treatment decisions in voluntary and involuntary psychiatry inpatients in Ireland and, in this analysis of our data-set, to elucidate the linear relationship, if any, between linear (as opposed to categorical) mental capacity and age. We used the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) to assess mental capacity for treatment decisions in 215 psychiatry inpatients (176 voluntary and 39 involuntary) in four psychiatry admission units in Ireland. Mean age was 46.2 years and majorities were male (58.1%), never married (74.0%), unemployed (64.2%) and of Irish ethnicity (87.0%). The most common primary diagnoses were schizophrenia and related disorders (42.8%) followed by affective disorders (36.7%). On multi-variable linear regression analysis, linear mental capacity was significantly associated with voluntary admission status, being employed, having a primary diagnosis other than schizophrenia or a related disorder, and younger age. Together, these factors accounted for 44.4% of the variance in mental capacity between participants. Overall, while increased age is associated with diminished mental capacity, other factors appear more significant, including involuntary admission status which is likely an indicator of symptom severity. There is a need for further research to (a) elucidate the relationships between the significant factors identified in this study and the cognitive status of patients (which impacts on assessments of mental capacity); (b) identify and elucidate other factors of likely relevance to mental capacity (e.g. medical illness, medication use); and (c) translate these findings into targeted interventions to support decision-making in clinical practice among psychiatry inpatients, especially those with involuntary status.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Tomada de Decisões , Competência Mental/psicologia , Transtornos Mentais/psicologia , Admissão do Paciente/estatística & dados numéricos , Adulto , Feminino , Hospitalização , Humanos , Irlanda/epidemiologia , Modelos Lineares , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria
15.
Int J Law Psychiatry ; 66: 101502, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706400

RESUMO

PURPOSE: Arrangements for the management of mentally disordered offenders vary widely across countries, as do rates of imprisonment and detention in forensic-psychiatric settings of such individuals. This study aims to quantify the characteristics of offenders detained in forensic-psychiatric settings in Germany over a 15 year period from 1995 and compare these with those sentenced to imprisonment over the same period. METHODS: Using official national statistical data, the index offences, demographic characteristics and criminal histories for all individuals convicted to forensic-psychiatric detention during the study period are described together with changes over time. This group was then compared with offenders convicted to a prison sentence of at least two years in the same time period for equivalent offences. RESULTS: Relevant differences and similarities between the two treatment groups were identified. Compared to offenders in prison, those in forensic care were older, with a higher proportion of women and a lower proportion of those with foreign backgrounds. Significant previous offending and levels of diminished responsibility were present in both groups. CONCLUSIONS: These findings provide data for future comparative research and indicate potential opportunities for earlier intervention to prevent trajectories into more serious offending, particularly in young people and those with mental disorder.


Assuntos
Internação Compulsória de Doente Mental/estatística & dados numéricos , Crime/estatística & dados numéricos , Prisioneiros/estatística & dados numéricos , Adulto , Feminino , Psiquiatria Legal , Alemanha , Humanos , Defesa por Insanidade , Masculino , Competência Mental/psicologia , Pessoa de Meia-Idade , Prisioneiros/psicologia , Prisões , Distribuição por Sexo
16.
Int J Law Psychiatry ; 66: 101501, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706406

RESUMO

This article explores the vulnerability that is created when legal capacity is denied to women and disabled women. It argues that vulnerability is largely contingent on social constructs - as opposed to being an inherent quality of disability or gender. It discusses barriers to the exercise of legal capacity that women and disabled women experience - such as limitations on reproductive choice, higher rates of substituted decision-making, and unique experiences with forced mental health treatment. It then explores evidence that such barriers are disempowering and can leave women and disabled women vulnerable to abuse and marginalisation. It explores financial, physical and sexual abuse that can occur as a result of this vulnerability. Finally, it concludes that autonomy and power are inextricably linked and can be essential for minimising vulnerability.


Assuntos
Tomada de Decisões , Pessoas com Deficiência/psicologia , Competência Mental/psicologia , Pessoas com Deficiência/legislação & jurisprudência , Feminino , Humanos , Competência Mental/legislação & jurisprudência , Autonomia Pessoal , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Direitos Sexuais e Reprodutivos/psicologia , Populações Vulneráveis/legislação & jurisprudência , Populações Vulneráveis/psicologia
17.
Int J Law Psychiatry ; 66: 101488, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706408

RESUMO

Respect for the sexual, reproductive, and relational choices of women with learning disabilities remains unrealised to date, despite the autonomy-based focus of mental capacity law in England and Wales as well as the UN Convention for the Rights of Persons with Disabilities. Instead, such women appear trapped within a triple-bind - where they not only act in ways that might reinforce oppressive norms around gender and disability, but they are mentally incapable of even making such self-subjugating choices. The triple-bind emerges for two reasons: first, learning disability is understood as an essentialist property that determines action; second, the normative logic of feminism and the social model of disability is bound to the binary between emancipation - subjugation, which excludes the nuanced and ambiguous agency of women with learning disabilities as a result. What is needed instead is an alternative framework of female agency that can accommodate a mode of ambivalence, indifference, inhabitation, and at times, complicity - in other words, instances where women make choices that appear contrary to their emancipation from disabling, patriarchal norms or relationships. Women with learning disabilities navigate a complex nexus of norms, power relations, and relational connections, some of which are coercive and oppressive, yet simultaneously subjectively affirming and enabling. I argue for an alternative analytical framework of female agency in order to accommodate how women with learning disabilities undertake the complex negotiation of power and social norms, as well as render visible their agency in their sexual, relational, and reproductive choices.


Assuntos
Pessoas com Deficiência/legislação & jurisprudência , Deficiências da Aprendizagem , Competência Mental , Autonomia Pessoal , Direitos Sexuais e Reprodutivos/legislação & jurisprudência , Pessoas com Deficiência/psicologia , Inglaterra , Feminino , Humanos , Deficiências da Aprendizagem/psicologia , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Direitos Sexuais e Reprodutivos/psicologia , Nações Unidas , País de Gales , Saúde da Mulher
18.
Int J Law Psychiatry ; 66: 101450, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706409

RESUMO

Cognitive assessment is central to the evaluation of testamentary capacity. Such assessment is currently performed in a subjective, unreliable and non-standardized manner. Dementia, a cognitive illness, poses one of the largest threats to testamentary capacity in modern society. A better understanding of the ways in which dementia related cognitive impairment can affect a testator's ability to meet the relevant legal criteria to make a will is needed. A review of the literature over the past ten years focusing on what cognitive abilities are required to satisfy the legal criteria for testamentary capacity has highlighted an alarming scarcity of work in this area. There is little discussion spanning beyond general acknowledgement of the importance of memory and executive function. The specifics of how cognitive impairment impacts the four limbs of Banks v Goodfellow are rarely addressed. Several additional areas of cognitive function of importance to assessing testamentary capacity are the subject of this article.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Demência/psicologia , Competência Mental , Atenção , Cognição , Prova Pericial , Humanos , Competência Mental/legislação & jurisprudência , Competência Mental/psicologia , Testes Neuropsicológicos
19.
Int J Law Psychiatry ; 66: 101503, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706410

RESUMO

Despite the central role in criminal trials, there is little research on the decision-making processes of experts in forensic psychiatry. We aimed to investigate the role of sociodemographic, psychopathological, and criminological characteristics in forensic psychiatric decisions on criminal responsibility and social dangerousness in criminal trials. We analyzed 302 forensic psychiatric reports provided by 16 forensic psychiatrists from the North, Central and Southern Italy. Defendants' psychiatric symptom severity was evaluated through the 24-item Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) scale and the Global Assessment of Functioning (GAF). Defendants judged not criminally responsible (Not-CRDs) presented with more severe psychiatric symptoms (positive symptoms, negative symptoms, manic excitement / disorganization), were more likely to be female, to be affected by a schizophrenia spectrum disorder, or bipolar spectrum disorder and to have had a higher number of previous psychiatric treatments and previous involuntary hospitalizations compared to their criminally responsible counterparts. Not-CRDs affected by a schizophrenia spectrum disorder, personality disorder, with severe psychiatric symptoms and with histories of criminal convictions and more victims were more likely to have received a judgment of social dangerousness. The forensic psychiatric evaluations were carried out on average of 770 days after the time of the crime, which in light of the other results, suggests an effect of the perceptions of the expert on the judgment of responsibility, raising the possibility of time bias on forensic judgments concerning defendants' mental responsibility.


Assuntos
Tomada de Decisões , Psiquiatria Legal/métodos , Defesa por Insanidade , Competência Mental/psicologia , Transtornos Mentais/psicologia , Adulto , Idoso , Comportamento Criminoso , Prova Pericial , Feminino , Psiquiatria Legal/instrumentação , Humanos , Itália/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Distribuição por Sexo , Comportamento Social
20.
Medicina (Kaunas) ; 55(10)2019 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-31569542

RESUMO

Background and Objectives: The complex concept of rational suicide, defined as a well-thought-out decision to die by an individual who is mentally competent, is even more controversial in the case of older adults. Materials and Methods: With the aim of better understanding the concept of rational suicide in older adults, we performed a systematic review of the literature, searching PubMed and Scopus databases and eventually including 23 published studies. Results: The main related topics emerging from the papers were: depression, self-determination, mental competence; physicians' and population's perspectives; approach to rational suicide; ageism; slippery slope. Conclusions: Despite contrasting positions and inconsistencies of the studies, the need to carefully investigate and address the expression of suicidal thoughts in older adults, as well as behaviours suggesting "silent" suicidal attitudes, clearly emerges, even in those situations where there is no diagnosable mental disorder. While premature conclusions about the "rationality" of patients' decision to die should be avoided, the possibility of rational suicide cannot be precluded.


Assuntos
Envelhecimento , Tomada de Decisões , Suicídio/psicologia , Idoso , Ageismo/psicologia , Envelhecimento/fisiologia , Envelhecimento/psicologia , Atitude Frente a Morte , Depressão/complicações , Depressão/diagnóstico , Nível de Saúde , Humanos , Competência Mental/psicologia , Autonomia Pessoal , Qualidade de Vida , Fatores de Risco , Suicídio/ética
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