Department of Psychological Medicine, Mental Health, Ethics and Law Research Group, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.
Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, Maryland, United States of America.
PLoS One. 2021 Feb 5;16(2):e0246521. doi: 10.1371/journal.pone.0246521. eCollection 2021.
BACKGROUND/OBJECTIVES: Many jurisdictions use a functional model of capacity with similar legal criteria, but there is a lack of agreed understanding as to how to apply these criteria in practice. We aimed to develop a typology of capacity rationales to describe court practice in making capacity determinations and to guide professionals approaching capacity assessments.
We analysed all published cases from courts in England and Wales [Court of Protection (CoP) judgments, or Court of Appeal cases from the CoP] containing rationales for incapacity or intact capacity(n = 131). Qualitative content analysis was used to develop a typology of capacity rationales or abilities. Relationships between the typology and legal criteria for capacity [Mental Capacity Act (MCA)] and diagnoses were analysed.
The typology had nine categories (reliability: kappa = 0.63): 1) to grasp information or concepts, 2) to imagine/ abstract, 3) to remember, 4) to appreciate, 5) to value/ care, 6) to think through the decision non-impulsively, 7) to reason, 8) to give coherent reasons, and 9) to express a stable preference. Rationales most frequently linked to MCA criterion 'understand' were ability to grasp information or concepts (43%) or to appreciate (42%), and to MCA criterion 'use or weigh' were abilities to appreciate (45%) or to reason (32%). Appreciation was the most frequently cited rationale across all diagnoses. Judges often used rationales without linking them specifically to any MCA criteria (42%).
A new typology of rationales could bridge the gap between legal criteria for decision-making capacity and phenomena encountered in practice, increase reliability and transparency of assessments, and provide targets for decision-making support.
背景/目的：许多司法管辖区采用具有类似法律标准的功能模型来评估能力，但对于如何在实践中应用这些标准，缺乏共识。我们旨在开发一种能力推理类型学，以描述法院在做出能力判断时的实践，并为专业人员进行能力评估提供指导。
我们分析了来自英格兰和威尔士法院的所有已公布案例（保护法院（CoP）判决或 CoP 的上诉案件），其中包含了无能力或有能力的理由（n=131）。使用定性内容分析来开发能力推理或能力的类型学。分析了类型学与能力的法律标准[《精神能力法》（MCA）]和诊断之间的关系。
该类型学有九个类别（kappa=0.63）：1）理解信息或概念，2）想象/抽象，3）记忆，4）欣赏，5）重视/关心，6）非冲动地思考决策，7）推理，8）给出连贯的理由，9）表达稳定的偏好。与 MCA 标准“理解”最常相关的理由是理解信息或概念的能力（43%）或欣赏的能力（42%），与 MCA 标准“使用或权衡”最相关的能力是欣赏的能力（45%）或推理的能力（32%）。在所有诊断中，欣赏是最常被引用的理由。法官经常使用理由，但没有将其具体与任何 MCA 标准联系起来（42%）。
一种新的推理类型学可以弥合法定决策能力标准与实践中遇到的现象之间的差距，提高评估的可靠性和透明度，并为决策支持提供目标。
