Advertisement

Irish Journal of Medical Science (1971 -)

, Volume 184, Issue 1, pp 31–46 | Cite as

The Assisted Decision-Making (Capacity) Bill 2013: content, commentary, controversy

  • B. D. Kelly
Review Article

Abstract

Background

Ireland’s Assisted Decision-Making (Capacity) Bill (2013) aims to reform the law relating to persons who require assistance exercising their decision-making capacity. When finalised, the Bill will replace Ireland’s outdated Ward of Court system which has an all-or-nothing approach to capacity; does not adequately define capacity; is poorly responsive to change; makes unwieldy provision for appointing decision-makers; and has insufficient provision for review.

Aims

To explore the content and implications of the Assisted Decision-Making (Capacity) Bill.

Methods

Review of the content of the Assisted Decision-Making (Capacity) Bill and related literature.

Results

The new Bill includes a presumption of capacity and defines lack of capacity. All interventions must minimise restriction of rights and freedom, and have due regard for “dignity, bodily integrity, privacy and autonomy”. The Bill proposes legal frameworks for “assisted decision-making” (where an individual voluntarily appoints someone to assist with specific decisions relating to personal welfare or property and affairs, by, among other measures, assisting the individual to communicate his or her “will and preferences”); “co-decision-making” (where the Circuit Court declares the individual’s capacity is reduced but he or she can make specific decisions with a co-decision-maker to share authority); “decision-making representatives” (substitute decision-making); “enduring power of attorney”; and “informal decision-making on personal welfare matters” (without apparent oversight).

Conclusions

These measures, if implemented, will shift Ireland’s capacity laws away from an approach based on “best interests” to one based on “will and preferences”, and increase compliance with the United Nations’ Convention on the Rights of Persons with Disabilities.

Keywords

Mental disorders Mental capacity Legal capacity Legislation and jurisprudence Social control Formal 

Notes

Acknowledgments

I am very grateful to the peer-reviewers for their helpful comments and suggestions.

Conflict of interest

None.

References

  1. 1.
    Leonard P, McLaughlin M (2009) Capacity legislation for Ireland: filling the legislative gaps. Ir J Psychol Med 26:165–168Google Scholar
  2. 2.
    Kelly BD (2011) Mental health legislation and human rights in England, Wales and the Republic of Ireland. Int J Law Psychiatry 34:439–454. doi: 10.1016/j.ijlp.2011.10.009 CrossRefPubMedGoogle Scholar
  3. 3.
    United Nations (2006) Convention on the rights of persons with disabilities. United Nations, GenevaGoogle Scholar
  4. 4.
    Bartlett P, Lewis O, Thorold O (2007) Mental disability and the European Convention on Human Rights (International studies in human rights, volume 90). Martinus Nijhoff Publishers, Leiden/BostonGoogle Scholar
  5. 5.
    Lynch K (2013) Balancing the scales of justice. Irish Examiner 24 September. http://www.irishexaminer.com/analysis/balancing-the-scales-of-justice-244008.html. Accessed 8 March 2014
  6. 6.
    Medical Council (2009) Guide to professional conduct and ethics for registered practitioners, 7th edn. Medical Council, DublinGoogle Scholar
  7. 7.
    Hughes JC (2013) Best interests. In: Jacob R, Gunn N, Holland A (eds) Mental capacity legislation: principles and practice. RCPsych Publications, London, pp 33–53Google Scholar
  8. 8.
    Bartlett P (2005) Blackstone’s guide to the Mental Capacity Act 2005. Oxford University Press, OxfordGoogle Scholar
  9. 9.
    Samsi K, Manthorpe J, Nagendran T, Heath H (2012) Challenges and expectations of the Mental Capacity Act 2005: an interview-based study of community-based specialist nurses working in dementia care. J Clin Nurs 21:1697–1705CrossRefPubMedGoogle Scholar
  10. 10.
    Bartlett P (2012) (2010) Informal admissions and deprivation of liberty under the Mental Capacity Act 2005. In: Gostin L, McHale J, Fennell P, Mackay RD, Bartlett P (eds) Principles of mental health law and policy. Oxford University Press, Oxford, pp 385–412Google Scholar
  11. 11.
    Shannon J (2013) New capacity Bill has gaps in human rights protection. Irish Med News 34:4Google Scholar
  12. 12.
    Hotopf M (2013) The assessment of mental capacity. In: Jacob R, Gunn N, Holland A (eds) Mental capacity legislation: principles and practice. RCPsych Publications, London, pp 15–32Google Scholar
  13. 13.
    Jacob R, Fistein E (2013) Clinical ambiguities in the assessment of capacity. In: Jacob R, Gunn N, Holland A (eds) Mental capacity legislation: principles and practice. RCPsych Publications, London, pp 96–108Google Scholar
  14. 14.
    Jacob R, Holland A (2013) Introduction. In: Jacob R, Gunn N, Holland A (eds) Mental capacity legislation: principles and practice. RCPsych Publications, London, pp 1–14Google Scholar
  15. 15.
    Welsh SF (2013) Provisions of the Mental Capacity Act 2005. In: Jacob R, Gunn N, Holland A (eds) Mental capacity legislation: principles and practice. RCPsych Publications, London, pp 54–77Google Scholar
  16. 16.
    Welsh SF, Keeling A (2013) The deprivation of liberty safeguards. In: Jacob R, Gunn N, Holland A (eds) Mental capacity legislation: principles and practice. RCPsych Publications, London, pp 78–95Google Scholar
  17. 17.
    Pidd H (2013) Grim tip of a forced marriage iceberg. Guardian 10 August. http://www.theguardian.com/world/2013/aug/09/mentally-disabled-forced-marriages-parents. Accessed 8 March 2014
  18. 18.
    Steering Group on the Review of the Mental Health Act 2001 (2012) Interim report of the Steering Group on the Review of the Mental Health Act 2001. Department of Health, DublinGoogle Scholar
  19. 19.
    Costello J (2013) Bill on assisted decision-making will support the vulnerable. Irish Times 29 JulyGoogle Scholar
  20. 20.
    Kennedy H (2012) ‘Libertarian’ groupthink not helping mentally ill. Irish Times 12 SeptemberGoogle Scholar
  21. 21.
    Kelly  BD (2013) Progressive Bill on assisted decision-making offers real hope for families and carers. Irish Times 28 October. http://www.irishtimes.com/news/ireland/irish-news/progressive-bill-on-assisted-decision-making-offers-real-hope-for-families-and-carers-1.1573403. Accessed 8 March 2014
  22. 22.
    Lewis O (2010) The expressive, educational and proactive roles of human rights. In: McSherry B, Weller P (eds) Rethinking rights-based mental health laws. Hart Publishing, Oxford and Portland, Oregon, pp 97–128Google Scholar
  23. 23.
    Kelly BD (2014) An end to psychiatric detention? Implications of the United Nations Convention on the Rights of Persons with Disabilities. Br J Psychiatry 204:174-175. Doi: 10.1192/bjp.bp.113.135475 Google Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2014

Authors and Affiliations

  1. 1.Department of Adult Psychiatry, UCD School of Medicine and Medical ScienceMater Misericordiae University Hospital, University College DublinDublin 7Ireland

Personalised recommendations