Walters Thomas Paul
St Thomas' Hospital Intensive Care Unit, Guy's and St Thomas' Foundation Trust , London, UK.
Br J Nurs. 2009;18(9):555-8. doi: 10.12968/bjon.2009.18.9.42259.
The stated aim of the Mental Capacity Act is to provide greater protection to those who may lose their mental capacities, particularly in terms of informed consent, patient affairs, advanced decisions and research. This article attempts to explore this new statute by way of examining the scope to which the Act departs from the previous Common Law. Three key themes are identified within this new Act, which differentiate it from Common Law: patients' best interests, which is paramount to any care or treatment; proxy consent, whereby donees can now be appointed to take charge of medical decisions; and advanced directives, where so-called living wills can be enforced provided that they are specific, written, signed and witnessed. However, upon examining the statute it appears that rather than increasing patient autonomy and self-determination, evidence suggests that power is still being held by the medical profession. Whether patients have full autonomy or not, the main issue could be how to strike an effective and workable balance between protection and liberty.
《精神能力法案》宣称的目标是为那些可能丧失精神能力的人提供更多保护，尤其是在知情同意、患者事务、预先决定和研究方面。本文试图通过审视该法案与先前普通法的背离程度来探讨这一新法规。在这部新法案中确定了三个关键主题，这使其有别于普通法：患者的最大利益，这对任何护理或治疗都至关重要；代理同意，即现在可以指定受赠人负责医疗决策；以及预先指令，只要所谓的生前遗嘱具体、书面、签署并经过见证，就可以执行。然而，在审视该法规时，证据表明，与其说它增加了患者的自主权和自决权，不如说权力仍掌握在医疗行业手中。无论患者是否拥有充分的自主权，主要问题可能是如何在保护和自由之间达成有效且可行的平衡。
