School of Law, University of Limerick, Limerick, Ireland.
Int J Law Psychiatry. 2022 Sep-Oct;84:101819. doi: 10.1016/j.ijlp.2022.101819. Epub 2022 Aug 2.
Healthcare decision-making can present challenges for the person with dementia as many of the skills needed to navigate the decision-making process may be diminished or lost as a result of dementia. Currently in Ireland the law responds to this difficult dilemma by providing for a system of adult guardianship - and outside of that, a great deal of uncertainty. This is set to change when the Assisted Decision-Making Capacity Act (ADMCA) 2015 comes into force in the summer of 2022. The ADMCA aims to provide a modern statutory framework that supports decision-making by adults and enables them to retain the greatest amount of autonomy possible in situations where they lack or may shortly lack legal capacity. The Act aims to do this both through creating a set of guiding principles for decision-making and by the creation of formal decision-making agreements. This article aims to examine the guiding principles of the Act as they affect the person with dementia, and to assess the degree to which they will support and guide people with dementia and their healthcare professionals in making decisions. The guiding principles are of singular importance because they will govern any treatment decision by or for a person which is not the subject of a formal agreement. In interrogating the guiding principles of the Act the article seeks to identify ways in which the ADMCA differs from the equivalent legislation in England and Wales, the Mental Capacity Act (MCA) 2005. The MCA came into force in 2007 and therefore the discussion is informed by almost fifteen years operation of the MCA. The article will argue that not only is the ADMCA a huge step forward from the current position in Ireland but that a number of key differences between the MCA and the ADMCA mean that the ADMCA has the potential to be more empowering for the person with dementia.
医疗保健决策可能会给痴呆症患者带来挑战，因为由于痴呆症，许多做出决策所需的技能可能会减弱或丧失。目前，在爱尔兰，法律通过提供成人监护制度来应对这一难题，而除此之外，还存在很多不确定性。当 2022 年夏季 2015 年《辅助决策能力法》（ADMCA）生效时，这种情况将会改变。ADMCA 的目的是提供一个现代的法定框架，支持成年人做出决策，并使他们在缺乏或可能很快缺乏法律能力的情况下尽可能保持最大的自主权。该法案旨在通过创建一套决策指导原则并创建正式的决策协议来实现这一目标。本文旨在研究该法案的指导原则对痴呆症患者的影响，并评估它们在多大程度上支持和指导痴呆症患者及其医疗保健专业人员做出决策。这些指导原则非常重要，因为它们将管辖任何不由正式协议涉及的人或代表其做出的治疗决定。在审查该法案的指导原则时，本文试图确定 ADMCA 与英国和威尔士等效立法《精神能力法》（MCA）2005 之间的区别。MCA 于 2007 年生效，因此该讨论受 MCA 实施近十五年的影响。本文将论证，ADMCA 不仅是爱尔兰目前立场的巨大进步，而且 MCA 和 ADMCA 之间的一些关键差异意味着 ADMCA 有可能为痴呆症患者提供更多的赋权。
