Taking wishes and feelings seriously: the views of people lacking capacity in Court of Protection decision-making

The Mental Capacity Act requires that where a person (P) lacks capacity to make a decision her wishes and feelings be taken into account when deciding what is in her best interests. This article considers how the Court of Protection evaluates evidence from P concerning her wishes and feelings. It finds that the Court ignores evidence regarding current wishes and fails to engage with more ambiguous evidence where P desires conflicting outcomes or may be concealing her true feelings. This is unhelpful since it makes the resulting judgment unconvincing to observers. It is legally problematic, since the Court should be following the practices of other decision-makers under the Mental Capacity Act (MCA). And it is ethically problematic since it undermines P's dignity and does not treat P as an actor whose evidence regarding her wishes and feelings has intrinsic status which the Court must make active efforts to engage with or discount rather than ignore

The discreditation of mad people within legal and psychiatric decision making: a systems theory approach

Luhmann defined social systems as structured around specific social codes, and comprised of the communications relating to that code. This thesis asks how the phenomenon of madness can be understood within this framework and argues that mad utterances are statements or acts which cannot be parsed according to any existing system of social or interpersonal meaning. The psy-disciplines transform these uncertain acts into stable meaning by defining them within a functionalist or pathological framework. These meanings are fragile because the operations of the psyche are socially invisible and so mad utterances have to be defined in relation to existing social systems of meaning. Mad utterances therefore generate uncertainty, which leads systems such as law and the economy to over-react to madness and discredit to a disproportionate degree what mad people have to say. The discreditation of mad people is problematic because it limits their personal autonomy. The ways in which systems exclude mad people, even when their stated objective is to promote their inclusion, is illustrated by the research literature on involvement in healthcare decision-making. The law plays a particular role in sustaining discreditable assumptions about mad people, and this is evidenced by a close examination of the research literature and case law relating to the Mental Health Review Tribunal in England and Wales. Luhmann's systems theory is not normative, so no clear normative agenda for change can be adduced from this description alone. Instead, this account offers a new theoretical framework within which to understand some of the shortcomings of mental health law, which is of particular relevance now that the involvement of mad people in decision-making them has been firmly placed on the legal and political agendas

Exploring the autistic and police perspectives of the custody process through a participative walkthrough

© 2019 The Authors Background: Research suggests that autistic individuals may be more likely to come into contact with police and have more negative experiences in police custody. However, limited information about the difficulties they experience during the custody process is available. Aims: This study explores the experiences of autistic individuals and officers during a walkthrough of the custody process to identify specific difficulties in these encounters and what support is needed to overcome these. Methods and procedures: A participative walkthrough method was developed to provide autistic individuals and officers an interactive opportunity to identify areas where further support in the custody process was needed. Two autistic participants and three officers took part in the study. Outcomes and results: Autistic participants reported negative experiences due to: i) the emotional impact of the physical setting and custody process ii) communication barriers leading to increased anxiety and iii) exposure to sensory demands. Officers highlighted three factors which limit their ability to support autistic individuals effectively: i) the custody context ii) barriers to communication and iii) knowledge and understanding of autism. Conclusions and implications: Adjustments are needed to the custody process and environment to support interactions between autistic individuals and officers and improve the overall wellbeing of autistic individuals

Perceptions of first-degree relatives of patients with rheumatoid arthritis about lifestyle modifications and pharmacological interventions to reduce the risk of rheumatoid arthritis development: a qualitative interview study

Background: There is increasing interest in the identification of people at risk of rheumatoid arthritis (RA) to monitor the emergence of early symptoms (and thus allow early therapy), offer lifestyle advice to reduce the impact of environmental risk factors and potentially offer preventive pharmacological treatment for those at high risk. Close biological relatives of people with RA are at an increased risk of developing RA and are therefore potential candidates for research studies, screening initiatives and preventive interventions. To ensure the success of approaches of this kind, a greater understanding of the perceptions of this group relating to preventive measures is needed. Methods: Twenty-four first-degree relatives of patients with an existing diagnosis of RA from the UK, three from Germany and seven from Austria (age: 21–67 years) took part in semi-structured interviews exploring their perceptions of RA risk, preventive medicine and lifestyle changes to reduce RA risk. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Many first-degree relatives indicated that they anticipated being happy to make lifestyle changes such as losing weight or changing their diet to modify their risk of developing RA. Participants further indicated that in order to make any lifestyle changes it would be useful to know their personal risk of developing RA. Others implied they would not contemplate making lifestyle changes, including stopping smoking, unless this would significantly reduce or eliminate their risk of developing RA. Many first-degree relatives had more negative perceptions about taking preventive medication to reduce their risk of RA, and listed concerns about potential side effects as one of the reasons for not wanting to take preventive medicines. Others would be more willing to consider drug interventions although some indicated that they would wish to wait until symptoms developed. Conclusions: Information targeted at those considered to be at risk of RA should contain information about RA, the extent to which risk can be quantified at an individual level and how risk levels may differ depending on whether early symptoms are present. The benefits (and risks) of lifestyle changes and pharmacological interventions as potential preventive measures should be clearly described

The discreditation of mad people within legal and psychiatric decision making : a systems theory approach

Luhmann defined social systems as structured around specific social codes, and comprised of the communications relating to that code. This thesis asks how the phenomenon of madness can be understood within this framework and argues that mad utterances are statements or acts which cannot be parsed according to any existing system of social or interpersonal meaning. The psy-disciplines transform these uncertain acts into stable meaning by defining them within a functionalist or pathological framework. These meanings are fragile because the operations of the psyche are socially invisible and so mad utterances have to be defined in relation to existing social systems of meaning. Mad utterances therefore generate uncertainty, which leads systems such as law and the economy to over-react to madness and discredit to a disproportionate degree what mad people have to say. The discreditation of mad people is problematic because it limits their personal autonomy. The ways in which systems exclude mad people, even when their stated objective is to promote their inclusion, is illustrated by the research literature on involvement in healthcare decision-making. The law plays a particular role in sustaining discreditable assumptions about mad people, and this is evidenced by a close examination of the research literature and case law relating to the Mental Health Review Tribunal in England and Wales. Luhmann's systems theory is not normative, so no clear normative agenda for change can be adduced from this description alone. Instead, this account offers a new theoretical framework within which to understand some of the shortcomings of mental health law, which is of particular relevance now that the involvement of mad people in decision-making them has been firmly placed on the legal and political agendas.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

People and Animals, Kindness and Cruelty: Research Directions and Policy Implications

This article addresses the challenges of defining and assessing animal abuse, the relation between animal abuse and childhood mental health, the extensive research on animal abuse and intimate partner violence, and the implication of these empirical findings for programs to enhance human and animal welfare. Highlighted are recent developments and advances in research and policy issues on animal abuse. The reader is directed to existing reviews of research and areas of focus on the expanding horizon of empirical analyses and programmatic innovations addressing animal abuse. Following a discussion of forensic and veterinary issues related to animal abuse, we discuss policy issues including how the status of animals as human companions at times may place animals at risk. We also review developments in the field of human–animal relations and apply the primary– secondary–tertiary prevention public health model to prevention and treatment of animal abuse. We close with a description of community networks addressing animal abuse, interagency collaborations, and new developments in animal-related law

Guillain-Barre syndrome and Fisher syndrome: Case definitions and guidelines for collection, analysis, and presentation of immunization safety data

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