Patient competence and professional incompetence: disagreements in capacity assessments in one Australian jurisdiction, and their educational implications

The determination of capacity to make medical, personal and financial decisions has significant individual and social implications. Medical and other health professionals are traditionally relied on by courts and tribunals to provide clinical and psychometric evidence of the presence or absence of capacity, or competence. Concern has long been expressed over the variability of these assessments. A survey of 285 decisions of the Queensland Guardianship and Assessment Tribunal (GAAT) between 2005 and 2008 was conducted to estimate the incidence of disagreement between health professionals in capacity assessments; to provide examples of conflicting assessments and models of assessment used; and to consider the educational implications of disagreements. While the final capacity determinations by the GAAT appear sound, this case series, and other studies in the capacity literature, strongly suggest the need to improve the education of health professionals, especially doctors, at undergraduate and postgraduate levels, in the practical assessment of capacity as a fundamental clinical skill.     

Liberals and Australian Foreign Policy*

Since the Second World War, Liberal governments trying to adapt to a rapidly changing international environment have been mindful of Australian interests, and especially the ongoing search for security. Adapting to declining British power, to militant communism in East and Southeast Asia, and to a new, under‐defined alliance with the United States was no easy task. The Colombo Plan for aid to South and Southeast Asia and the dismantling of the White Australia Policy represented two forms of positive engagement with Asia. Since the 1970s, Liberal governments have played significant roles in the strengthening of the Commonwealth; strengthening ties with key countries in Asia; and maintaining a sometimes problematic security relationship with the United States. On this latter point, however, the most recent Liberal governments have not performed well, in becoming more subservient to the Americans.     

Reviews

Ference Feher, Agnes Heller and Gyorgy Markus, Dictatorship Over Needs, Oxford: Basil Blackwell, 1983, xiii+312 pp. £22.50.

Pierre Kende and Zdenek Strmiska, (Eds.) Egalités et inégalités en Europe de l’ Est, Presses de la Fondation Nationale des Sciences Politiques, Paris, 1984.

Lewis H. Siegelbaum, The Politics of Industrial Mobilisation in Russia, 1914–17: A Study of the War‐Industries Committees, London, Macmillan (in association with St. Antony's College, Oxford), 1983, xix + 312 pp. £25.00

William J. Conyngham, The Modernization of Soviet Industrial Management, Cambridge University Press, 1982, pp. 332 + ix. £19–50.

Caroline Humphrey, Karl Marx Collective: Economy, society and religion in a Siberian collective farm. Cambridge, Melbourne, Sydney: Cambridge University Press, 1983. xviii + 522 pp. £30–00 (£10–95 paperback).

Victor Zaslavsky and Robert J. Brym, Soviet Jewish Emigration and Soviet Nationality Policy, London, Macmillan, 1984, vii + 185 pp. £20.00.

James E. Mace, Communism and the Dilemmas of National Liberation: National Communism in Soviet Ukraine 1918–1933, Harvard University Press for the Harvard Ukrainian Research Institute and the Ukrainian Academy of Arts and Sciences in the U.S., Cambridge, Mass. 1983. xiv + 334 pp. $21.50.

Kalman Rupp, Entrepreneurs in Red, State University of New York Press, Albany, N.Y., 1983. 260 + xvii pp. £37.60 (hardback) £14.25 (paperback).

Cole Blasier, The Giant's Rival: the USSR and Latin America. Pittsburgh: University of Pittsburgh Press, 1983, xvi + 213 pp. $7.95 (paperback).     

The origins of penal populism

Five years ago after 46 years of daily deadlines – the last 38 on The Guardian – I retired to explore, with the help of Joseph Rowntree Foundation and Nuffield College Oxford fellowships, just how much influence was played by the media in the policy making process. The exercise was prompted by rising public concern over the ever widening power of the media. Onora O'Neill, the philosopher, in her Reith lectures in 2002 on trust in public institutions, noted with irony that the main champion of transparency and accountability – the media – were themselves the least transparent and accountable group in democracy. Anthony Sampson, a distinguished journalist, in his fourth edition of Anatomy of Britain in 2004, documented just how entrenched this perception was.