Suchergebnisse

Like the U.S. political system as a whole, the presidency has grown far more open to members of the public and, especially, to organised interests. Over roughly the same period, the presidency has become less permeable to much of the expertise and experience available within the executive branch. Together, these two features have contributed to weaknesses in the decision‐making capacity of the institution, with implications for policy effectiveness and perceived legitimacy. This article sketches the bases for the claim of attenuated decision capacity and its implications. After arguing that changes in rules and structuring may help strengthen presidential decision‐making capabilities, the article goes on to propose several such alterations.

Background: Dementia is a common cause of altered decision-making capacity. Determining whether an individual has the ability to make a specific decision can be very challenging for both clinicians and researchers. UK legislation requires that we both promote residual capacity where possible, and protect vulnerable adults who cannot make independent decisions. We evaluated published instruments designed to aid in the assessment of capacity, focussing on those meeting UK legal requirements. We also consider further disease and culture specific factors which may influence decision making. Methods: A search of electronic databases was made for articles published between 2000 and 2017 detailing structured tools for the assessment of mental capacity. These were evaluated against UK legal requirements. Results: Nine tools were identified which fulfilled UK legal requirements. Their design and structure varied, as did the level of reliability and validity data available. Some instruments can be tailored for a specific decisional scenario, whilst others are designed for use by particular patient groups. Discussion: A wide range of mental capacity assessment instruments are available, but not all fulfil UK legal requirements. Healthcare professionals and researchers should be mindful of personal, cultural and disease specific factors when assessing capacity. No gold standard for capacity assessment exists, which hampers the evaluation of different approaches. A combination of the opinion of a healthcare professional or researcher trained in capacity evaluation, plus the use of a structured assessment tool is the most robust approach.

This article explores issues associated with impaired decision‐making capacity for Indigenous Australians. There is very little published on the subject of impaired decision‐making capacity in Australia, particularly in relation to Indigenous people. To gain some insight into this subject, this article looks at some indicators of impaired decision‐making capacity for Indigenous Australians such as rates of intellectual disability and mental illness. The Australian state‐based Guardianship and Administration system—the legislative framework designed to provide for decision‐making for people with impaired capacity—is briefly described before looking at the cultural relevance of this Western system and its constructs for Indigenous Australians. Future investigation should be directed at exploring existing and alternative strategies to support Indigenous Australians with impaired capacity and their carers.

New legislation should raise the moral standards of professional and personal life, but the proposed new mental health bill fails to deal with serious ethical problems in the existing act

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) has led to a re-thinking of traditional mental health law around the world. Since Australia's ratification of the CRPD, all but one of its eight jurisdictions have introduced reforms to mental health legislation. These are aimed, in part, towards compliance with the Conventions articles. This paper examines the meaning and operation of the reforms introduced in Australia's second most populous state – Victoria.We first describe the criteria for involuntary treatment set out in the new Mental Health Act 2014 (Vic) (Austl.) (the Act). We then argue that when making an order for Involuntary Treatment, the Victorian Mental Health Tribunal (the Tribunal) is obliged to carefully consider a person's decision-making capacity as part of ensuring that treatment is provided in the least restrictive way, and to only authorise the involuntary treatment over a person's competent objection in very limited circumstances.Having established the way in which the Act should operate, we then present two empirical studies which analyse the decisions of the Statements of Reasons of the Tribunal to gain some appreciation of how the Act is working. These indicate that seldom does the Tribunal consider the decision-making capacity of people brought before it, and that, even when this is considered, the relevant information is not being used protectively so as to uphold a right to competently refuse treatment. Instead, the Tribunal uses the presence or absence of decision-making capacity, insight or poor judgement, to determine if a person is mentally ill or if treatment is required to prevent serious harm. We conclude that the Tribunal's practice is inconsistent with the principles of the Act and consequently the intention of Parliament.

Many more people are reaching old age than ever before, and older people are increasingly living longer. As the nation experiences this unprecedented growth of older Americans, geriatric case managers are likely to encounter many clients at very advanced ages. Concomitantly, practitioners will confront elders with questionable decision-making capacity, as dementia and other cognitive impairments are more common among the older age groups. These clients pose potential safety and well-being concerns and may be vulnerable to exploitation, neglect, and abuse in their homes. Case managers' responses to such client scenarios may range from little involvement, by acquiescing to the client's right to make autonomous decisions, to resorting to legal action, which may lead to a substantial loss of rights for the elder. This article provides considerations for practice with elders presenting with questionable decision-making capacity and precarious living situations. The distinction between capacity and competency is presented and factors affecting decision making are discussed. Ethical aspects are addressed and the process of assessing capacity is reviewed to enhance case managers' practices in this area.

Although the topic of decision making capacity and older persons has been discussed in the literature, there still is much to be learned about it theoretically and practically. Experts continue to disagree about which standards are important for assessing decision making capacity. Questions such as: "When should a capacity assessment be done on an older person and by whom?" are covered by the editors. Topics included in this volume are the application of an original framework for ethical decision making in long term care; an elder's capacity to decide to remain living alone in the co

"In May 2004, Malta, Cyprus and eight Central and Eastern European countries joined the European Union (EU). This raises the question whether the increasing heterogeneity of the new EU member states, their different memories, interests, ideas and identities will have a negative effect on the policy-making process of the EU or if the integration dynamic of the EU can be maintained. Analytically, three different aspects of such a capacity to act can be distinguished: The capability to enforce compliance with the European legislation and rules, the decision-making capability of the EU organisations and the capability to advance further political projects. 1. The implementation of the Community acquis was a crucial membership criterion in order to preserve the central 'club goods' of the EU, especially the Common Market and the competition rules. 2. The decisionmaking capability of the EU is challenged by the accession of ten mostly smaller and poorer countries. Until the date of accession, the former member states could not agree upon the required fundamental reforms of the institutional architecture, the budget and the redistributive policies. 3. A prerequisite for further political projects is the readiness of the 25 member states to cooperate. This requires a new balance between the equality of sovereign nations and a stronger influence of bigger states. The development of such a balance is considerably impeded by the process and the results of the extremely asymmetric accession negotiations. It can be concluded that compliance with European rules was largely assured, but it is still open to question as to whether the organisational and political prerequisites for the European capability for action can be restored after the successful enlargement process." (author's abstract)