The Place of Wishes and Feelings in Best Interests Decisions: Wye Valley NHS Trust v Mr B

In Wye Valley NHS Trust v Mr B the Court of Protection decided that it was not in the best interests of Mr B to receive amputation surgery against his will, notwithstanding that he would die without the treatment. The judge met with Mr B in person and his best interests decision placed significant weight on Mr B's wishes and feelings. This case note considers this influential case in the context of ongoing debate about the place of wishes and feelings in best interests decisions under the Mental Capacity Act 2005. It considers the history of the best interests principle, its interpretation by the Supreme Court in Aintree University Hospitals NHS Foundation Trust v James, ongoing debates about its compatibility with Article 12 of the United Nations Convention on the Rights of Persons with Disabilities, and recent proposals by the Law Commission for statutory amendments to the Mental Capacity Act.     

The Rise of Statutory Wills and the Limits of Best Interests Decision‐Making in Inheritance

This article addresses ‘statutory wills’ executed under the Mental Capacity Act 2005 (MCA) for persons with impaired mental capacity. The article provides an overview of the historical development of statutory wills, before exploring their rising contemporary significance. It considers the shift from the previous ‘hypothetical substituted judgment’ test to the contemporary ‘best interests’ orientation of the MCA. The article assesses the problems that the best interests approach raises in this area, and its (in)compatibility with the right to equal recognition before the law under the UN Convention on the Rights of Persons with Disabilities, arguing that the pervasive reach of best interests in contemporary mental capacity law requires reconsideration. The paper concludes by suggesting that a more limited framing of the power to execute statutory wills is required in order to appropriately balance the rights of individuals with disabilities with practical considerations around the distribution of assets on death.     

From ‘Doctor Knows Best’ to Dignity: Placing Adults Who Lack Capacity at the Centre of Decisions About Their Medical Treatment

In 1989, the House of Lords first derived a ‘best interests’ test for the medical treatment of adults who lack capacity from the doctrine of necessity and, now codified, the test continues to apply today. The Mental Capacity Act 2005 sets out a non‐exhaustive checklist of relevant considerations, but it gives no particular priority to the patient's wishes. There is also no formal expectation that the patient will participate directly in any court proceedings in which her best interests are to be determined. This article will consider the advantages and disadvantages of providing additional guidance to decision‐makers in order to help them navigate both taking seriously the wishes of people who lack capacity and, at the same time, not abandoning patients who need help and support. More specifically, this article advocates formalising current best practice in the Court of Protection through the introduction of a series of rebuttable presumptions, or starting points.     

The Law and Incapacity Determinations: A Conflict of Governance?

This article will consider the highly charged questions raised by two major sets of law reforms in England and Wales, the Mental Capacity Act 2005 and the Mental Health Act 2007, which, although applying to closely related clinical populations, proceeded along entirely separate legislative paths. By justifying its proposals for reform of mental health legislation on the grounds of 'risk', the Government failed to take into account the implications of enforced treatment on patients who may retain decision-making capacity.     

What do NHS staff learn from training on the Mental Capacity Act (2005)?

Purpose. Many studies have reported that professionals have a limited understanding of mental capacity issues. Implementation (in England and Wales) of the Mental Capacity Act (MCA) (2005) presents a challenge to services. The aim of this study was to evaluate the extent to which National Health Service (NHS) staff benefited from attending MCA training courses. Methods. Participants were assessed before and after MCA training using a structured interview, which included three scenarios describing mental capacity dilemmas, four vignettes addressing the role of the Independent Mental Capacity Advocate (IMCA), and 16 true–false items. Results. Interview performance improved post‐training, but this could be largely ascribed to an increased awareness of mental capacity issues, with minimal improvements in the knowledge that would be needed to undertake the assessments. Nine areas were identified where there remained significant gaps in participants’ knowledge post‐training. Participants with experience of dealing with mental capacity issues performed better than those without. Conclusions. The results suggest that methods other than formal training events may be needed to prepare health staff to implement new legislation.     

Transfers from prison to hospital under Sections 47 and 48 of the Mental Health Act between 2011 and 2014

In England and Wales, prisoners with mental disorder of such severity as to warrant inpatient treatment may be transferred to hospital under the Mental Health Act. UK Government guidance recommends that this process should be completed within 14 days; however, evidence suggests that in many cases it can take much longer. This retrospective service evaluation of 64 male prisoners, who were transferred under Section 47 or Section 48, aimed to evaluate transfer durations. The mean time from referral to admission was 76 days. Prisoners with a psychotic disorder were admitted more quickly. Remand prisoners were admitted more quickly than sentenced prisoners. Findings suggest that, in the UK the transfer time of prisoners under Sections 47 and 48 of the Mental Health Act continues to far exceed the 14-day target which raises concern about equivalence of care for prisoners. Our findings support arguments for fundamental amendments to the admissions process.     

Medicaid program; demonstration proposals pursuant to section 1115(a) of the Social Security Act; policies and procedures--HCFA and ACF. Public notice

This public notice informs interested parties of (1) the principles the Department of Health and Human Services ordinarily will consider when deciding whether to exercise its discretion to approve or disapprove demonstration projects under the authority in Section 1115(a) of the Social Security Act, 42 U.S.C. section 1315(a); (2) the kinds of procedures the Department would expect States to employ in involving the public in the development of proposed demonstration projects under Section 1115; and (3) the procedures the Department ordinarily will follow in reviewing demonstration proposals. The principles and procedures described in this public notice are being provided for the information of interested parties, and are not legally binding on the Department of Health and Human Services. This notice does not create any right or benefit, substantive or procedural, enforceable at law or equity, by any person or entity, against the United States, its agencies or instrumentalities, the States, or any other person.     

Special surveillance list of chemicals, products, materials and equipment used in the clandestine production of controlled substances or listed chemicals. Drug Enforcement Administration (DEA), Justice. Final notice

On October 3, 1996, the Comprehensive Methamphetamine Control Act of 1996 (MCA) was signed into law. The MCA makes it unlawful for any person to distribute a laboratory supply to a person who uses, or attempts to use, that laboratory supply to manufacture a controlled substance or a listed chemical, with reckless disregard for the illegal uses to which such laboratory supply will be put. Individuals who violate this provision are subject to a civil penalty of not more than $25,000; businesses which violate this provision are subject to a civil penalty of not more than $250,000. The term "laboratory supply" is defined as "a listed chemical or any chemical, substance, or item on a special surveillance list published by the Attorney General, which contains chemicals, products, materials, or equipment used in the manufacture of controlled substances and listed chemicals." This final notice contains the list of "laboratory supplies" which constitutes the Special Surveillance List that was required to be published by the Attorney General pursuant to Title 21, United States Code, Section 842(a).     

Violence ratings of female patients in broadmoor hospital

Abstract

A study is described which characterised the female population of Broadmoor Special Hospital on a scale (Robertson et al., 1987) which rates violence associated with the index offence and previous episodes of violence both in terms of prosecuted violence and unprosecuted incidents. This scale has been applied recently to the male population of Broadmoor (Wong et al., 1993). The findings here confirm the notion that the female population of a Special Hospital are less violent than the males in terms of rating of violence associated with the index offence and in previous convictions for violent offending. The females contain a larger proportion of patients convicted of the offence of Arson (index offence) and patients transferred from other hospitals because of being unmanageable in these settings (under Section 3 of the Mental Health Act). Extreme ratings of violence amongst the females is associated with a diagnosis of personality disorder rather than schizophrenia or psychosis.     

'The necessity must be convincingly shown to exist': standards for compulsory treatment for mental disorder under the Mental Health Act 1983

Current English law has few controls on the involuntary treatment of persons detained under the Mental Health Act 1983. In 2001, R (Wilkinson) v. Broadmoor Special Hospital Authority provided some hope that, in conjunction with the Human Rights Act and the European Convention on Human Rights (ECHR), meaningful substantive and procedural standards for compulsory psychiatric treatment might be developed, but that hope has not been fulfilled. Using Wilkinson and the ECHR jurisprudence as a starting point, this article considers when, if at all, compulsory psychiatric treatment might be justified. In particular, it considers the difference between the 'appropriateness' standard of the English legislation and the ECHR requirement of 'therapeutic necessity', the requirements for appropriate procedure and appropriate legislative clarity, how the courts should deal with disagreements among treating physicians, and the relevance of the capacity and best interests of the detained person.     

Does the Statutory Regulation of Advance Decision-Making Provide Adequate Respect for Patient Autonomy?

This paper considers advance decision-making in the context of healthcare. The common law recognition of advance decisions is contrasted with new statutory provision. This paper will examine the Mental Capacity Act 2005 framework for advance decisions and lasting powers of attorney. The ‚best interests’ test and substituted judgment as criteria for proxy decision-making are compared by application to a case example. The paper examines the statutory safeguards in respect of refusals of ‚life-sustaining treatment’ and postulates that these safeguards may render respect for autonomous advance decision-making difficult to achieve in practice.     

The good,the bad,and the ‘vulnerable older adult’

Recent declarations by the Court of Appeal indicate that the inherent jurisdiction has survived the implementation of the Mental Capacity Act 2005 for adults considered ‘vulnerable’ and whose decision-making is threatened by reasons other than mental impairment – such occasions may include instances of elder abuse. In this paper I argue, however, that the post-Mental Capacity Act courts have adopted a confused and outmoded concept of the vulnerable older adult, in particular where decision-making is threatened by abusive interpersonal relationships experienced by an older individual. This has particular implications in terms of the types of remedies imposed by the courts on older adults in such circumstances. In this article I suggest that by being more cognisant of recent more nuanced understandings of vulnerability, the courts may be better suited to identifying, and responding to perceived sources of vulnerability in a way that is more empowering for the older adult.     

Reforming the Mental Health Act 1983: an approved social worker perspective

The government green paper, 'Reform of the Mental Health Act 1983', was published in November 1999, for consultation by end of March 2000. This article offers comment on the operation of the Mental Health Act 1983 and the proposals for change, from an approved social worker perspective. Under the Mental Health Act 1983, approved social workers undertake social assessments of mental health crises, deciding upon the need for compulsory admission and treatment. To the debate on legislative change they bring a detailed social perspective on the processes and outcomes of statutory mental health intervention. Approved social workers' main concerns relate to the social context of mental health need, the availability of social resources, civil liberties, protections for people subject to statutory mental health interventions and the effective regulation of practice and services. Current proposals include options that would significantly reduce approved social worker involvement in decisions about compulsory admission and treatment; the implications of this are discussed.     

Transfers of mentally disordered adolescents from custodial settings to psychiatric hospital in England and Wales 2004–2014

This article has used data provided by the Ministry of Justice to track changes in the number of adolescents under the age of 18 transferred from secure custodial institutions, who have required transfer to psychiatric hospital using Section 47 and Section 48 of the Mental Health Act. During the period 2004–2014 there were large reductions in the population of young people detained in custody in England and Wales. The number of young people requiring hospital transfer fell during this period but to a much lesser degree. The possible reasons for this are discussed and include the increased complexity of young people in custody and the increased availability of secure psychiatric beds.     

我国惩治黑社会性质组织犯罪的刑法完善——兼论对《刑法修正案(八)(草案)》相关条款的修改建议

现行《刑法》关于黑社会性质组织犯罪的规定在司法实践中存在着理解和认定上的困难,已经不能适应惩治黑社会性质组织犯罪的新要求,有必要重视重庆打黑除恶专项斗争中暴露出的刑法规定上的不足,对《刑法修正案(八)(草案)》的相关规定予以评述并提出相应的修改建议。当前,我国没有必要制定单独的反黑社会性质组织犯罪法律。在修订《刑法》第294条时,应当区别对待组织、领导者和积极参加者、一般参加者,并设置相应的刑罚,同时应当增设第294条之一以界定黑社会性质组织。对于所有黑社会性质组织犯罪均应增设财产刑,并提高包庇、纵容黑社会性质组织犯罪的法定刑。此外,不宜将黑社会性质组织犯罪规定为特殊累犯,而应当规定为特别再犯,并提高黑社会性质组织犯罪的缓刑、减刑和假释适用标准。     

Restraint in order to feed: justifying a lawful policy for the UK

In the UK, restraining medical patients in order to provide care is widely considered to be outmoded and difficult to justify. The prevailing clinical intuition that restraining patients is generally wrong (even when restraint is essential in order to provide artificial nutrition and hydration) has prompted us to develop a policy that is compatible with common law, the Mental Capacity Act 2005 and the Human Rights Act 1998. The nature and scope of the problem are illustrated with clinical cases. These, in turn, serve to demonstrate the tension that arises between article 2, article 3 and article 8 rights, when incompetent patients are restrained in order to feed.     

Autonomy, guardianship and mental disorder: one problem, two solutions

The law in England and Wales governing both the provision of medical care in the case of adults with incapacity and the provision of care and treatment for mental disorder presents serious problems for the principle of patient autonomy. The adult with incapacity has no competence either to consent to or refuse medical treatment but the law provides no statutory structure for substitute decision making on that adult's behalf. On the other hand the law does allow a person with mental disorder to be treated for that disorder despite his or her competent refusal. The nature of these inconsistencies is considered and the implications which flow from the singling out of mental disorder are examined with reference to experience in two Australian jurisdictions. The current proposals for reform of the Mental Health Act are then considered in the light of the conclusions drawn.     

物权主体论纲

国家享有以及行使国家所有权,均表现其作为公权载体的性质而非作为私权载体(法人)的性质。不论是农村“集体”还是城镇“集体”,在物权法上都没有其主体地位。法人应为其财产的所有权主体,非法人团体不具有独立财产,不得享有财产所有权和他物权。物权法上的物权主体应为自然人与法人,国家作为具有公权性质的国家所有权的主体,在物权法上具有不同于自然人与法人的特殊主体地位,而集体与非法人组织,均非物权主体。     

Conservatorship of Wendland: in the Supreme Court of California

HELD: A conservator of the person may not withhold tube feeding from a conscious conservatee who is not terminally ill, comatose, or in a persistent vegetative state, absent clear and convincing evidence that the conservator's decision is in accordance with either the conservatee's own wishes or his best interest.     

The ‘Hybrid Order’: origins and usage

The hospital direction (Hybrid Order) was inserted into the Mental Health Act (MHA) in 1997 (Crime (Sentences) Act, 1997). It enables higher courts to direct hospital admission for offenders, whilst still imposing a prison sentence. The origins of the ‘Hybrid Order’ and its patterns of usage are examined. Comparisons are made with its Scottish equivalent, Section 59A of the Criminal Procedure (Scotland) Act 1995. Both the ‘Hybrid Order’ and Section 59A have been used infrequently. This may reflect the fact that they were strongly resisted on ethical grounds at their point of inception and that they force the psychiatrist into the position of ‘punisher’, rather than ‘treater’. Since the 2007 Amendment of the MHA in England and Wales which expanded the remit of the ‘Hybrid Order’ to include all legal categories of mental disorder, not solely psychopathy, its use has unsurprisingly increased – this article delineates the considerations that need to be given in its recommendation.