Shah Ajit, Banner Natalie, Heginbotham Chris, Fulford Bill
Institute for Philosophy, Diversity and Mental Health, University of Central Lancashire, Preston and West London Mental Health NHS Trust, London, UK.
Int Psychogeriatr. 2009 Oct;21(5):922-30. doi: 10.1017/S1041610209990391. Epub 2009 Jun 25.
The Mental Capacity Act 2005 (MCA) was fully implemented in October 2007 in England and Wales. The experience of clinicians working in Old Age Psychiatry, who are likely to have greater experience in the use of MCA, in the early implementation of the MCA was examined.
Case-notes of 37 patients in seven different Old Age Psychiatry services in two mental health trusts in west London, who had received at least one assessment of decision-making capacity (DMC) for a specific issue, were examined. A qualitative thematic analysis pertaining to the criteria used for the assessment of DMC, determination of best interests, least restrictive option and unwise decision was used for data analysis.
The main findings were: the criteria used for the assessment of DMC and the determination of best interests were those described in the MCA and the accompanying Code of Practice; and clinicians were developing the concepts of least restrictive option and unwise decision with face validity despite the absence of their definitions in the MCA.
Caution should be exercised in extrapolating the findings of this study, which is confined to two Mental Health Trusts in one geographical area and the speciality of Old Age Psychiatry, to other localities and other specialties. Nevertheless, there was evidence that clinicians were following the basic principles of the MCA correctly.
《2005年精神能力法案》（MCA）于2007年10月在英格兰和威尔士全面实施。本研究调查了老年精神病学领域临床医生在MCA早期实施过程中的经验，这些医生可能在使用MCA方面有更丰富的经验。
对伦敦西部两个精神卫生信托机构中七个不同老年精神病学服务部门的37名患者的病历进行了检查，这些患者针对特定问题至少接受过一次决策能力（DMC）评估。采用定性主题分析方法，对评估DMC、确定最佳利益、限制最少的选择和不明智决策所使用的标准进行数据分析。
主要发现如下：评估DMC和确定最佳利益所使用的标准是MCA及配套《实践守则》中所述的标准；尽管MCA中没有对限制最少的选择和不明智决策进行定义，但临床医生正在发展具有表面效度的这两个概念。
本研究仅限于一个地理区域内的两个精神卫生信托机构以及老年精神病学专业，在将研究结果推广到其他地区和其他专业时应谨慎。尽管如此，有证据表明临床医生正确遵循了MCA的基本原则。
