assisted-decision making bill 2013 (republic of ireland)

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Mental Health and Incapacity. Analysis of draft Legislation.


  • 1. Assisted Decision-Making (Capacity)Bill 2013Anselm Eldergill

2. Headings1 Introduction2 Definitions3 Capacity4 Statutory principles5 Statutory mechanisms6 Assistance agreements and co-decision-makingAnselm Eldergill 3. 1 INTRODUCTIONAnselm Eldergill 4. Capacity Is the legal ability to bear and exercise rights orto be affected by legal duties or liabilities.RIGHTS CAPACITY Capacity to have and exercise rights, e.g. voting,agreeing contracts, making a will.LIABILITY CAPACITY (RESPONSIBILITIES) Capacity to be held legally liable for contracts,torts, crimes, etc.Anselm Eldergill 5. Individual responsibilityThe counterpart offreedom and autonomyis accountability for actsfreely andautonomously done.Anselm Eldergill 6. AUTONOMYCAPACITYfor autonomous actionFREEDOMto act autonomouslyRequiresReduced byLACK OF CAPACITYfor autonomous actionRESTRAINTSon autonomous actionEldergillLiberal obligationsAnselm RISK-BASED, JUST,LIBERAL, RULE OF LAW BENEFICENCESubstitute decisionPractical assistance 7. Liberty, treatment, safety The extent of a people's liberty to chooseto live as they desire must be weighedagainst the claims of many other values, ofwhich equality, or justice, or happiness, orsecurity, or public order are perhaps themost obvious examples. (Berlin) Ultimately, whether individuals should beallowed certain liberties at all depends onthe priority given by society to differentvalues and the crucial point is the criterionby which it has to be decided that aparticular liberty should or should not beallowed, or that its exercise is in need ofrestraint. (Dias) 8. Laws should be A last resort Impose minimum powers, duties and rights Unambiguous Just As short as possible In plain English provide a mechanism for enforcing duties provide a remedy when powers are exceededAnselm Eldergill 9. 2 DEFINITIONS 10. DefinitionsDecision includes a class of decisionsIntervention an action taken under this Act in respect of the RPby the court or High CourtRelevant person (a) a person whose capacity is being called intoquestion or may shortly be called into question inrespect of one or more than one matter, and includessuch a person who is(i) an appointer, or(ii) the donor of an enduring power of attorney,(b) a person who lacks capacity in respect of one ormore than one matter in accordance with theprovisions of this Act, or(c) a person who falls within paragraphs (a) and (b)at the same time but in respect of different matters,as the case requires.Anselm Eldergill 11. 3 CAPACITYAnselm Eldergill 12. Assessing capacity3.(1) Subject to subsections (2) to(6), for the purposes of this Act(including for the purposes ofcreating a decision-makingassistance agreement, co-decision-makingagreement or enduringpower of attorney), a personscapacity shall be assessed on thebasis of his or her ability tounderstand the nature andconsequences of a decision to bemade by him or her in the context ofthe available choices at the time thedecision is made.Anselm Eldergill 13. Lack of capacity to make adecision3.(2) A person lacks the capacity to make a decision if heor she is unable(a) to understand the information relevant to the decision,(b) to retain that information,(c) to use or weigh that information as part of the process ofmaking the decision, or(d) to communicate his or her decision (whether by talking,writing, using sign language, assisted technology, or anyother means) or, if the implementation of the decisionrequires the act of a third party, to communicate by anymeans with that third party.Anselm Eldergill 14. AAnn iimmppaaiirrmmeennttooff,, oorr aaddiissttuurrbbaannccee iinntthhee ffuunnccttiioonniinnggooff,, tthhee mmiinndd oorrbbrraaiinn IItt ddooeess nnoottmmaatttteerr wwhheetthheerrtthhee iimmppaaiirrmmeennttoorr ddiissttuurrbbaanncceeiiss ppeerrmmaanneenntt oorrtteemmppoorraarryy..TThhee ppeerrssoonn iissuunnaabbllee ttoo mmaakkee aaddeecciissiioonn iinnrreellaattiioonn ttoo tthheemmaatttteerr ffoorrhheerr//hhiimmsseellffuunnaabbllee ttoo rreettaaiinn tthhaattiinnffoorrmmaattiioonnuunnaabbllee ttoo ccoommmmuunniiccaatteetthheeiirr ddeecciissiioonn ((wwhheetthheerrbbyy ttaallkkiinngg,, uussiinngg ssiiggnnllaanngguuaaggee oorr aannyy ootthheerrmmeeaannss)).... .uunnaabbllee ttoo uunnddeerrssttaanndd tthheeiinnffoorrmmaattiioonn rreelleevvaanntt ttootthhee ddeecciissiioonn,,uunnaabbllee ttoo uussee oorr wweeiigghhtthhaatt iinnffoorrmmaattiioonn aass ppaarrttooff tthhee pprroocceessss ooffmmaakkiinngg tthhee ddeecciissiioonn,,Compare with 2005 ActThere is no reference in the 2013 Bill to an impairment ordisturbance in the functioning of the mind or brain being the causeof the persons inability to make a decision. Is this of any practicalsignificance in terms of the range of people or actions covered? Doesthis stray into inherent-jurisdiction type cases? 15. 15SScceennaarriiooss Emma is in a violent and abusive relationship from whichshe seems unable to extricate herself. She will not or cannotapply for an injunction. John has an IQ of 80. He refuses cardiac surgery which theconsultant tells him is necessary to address a significant riskof a fatal heart attack. John is aged 18. He is extremely immature for his age. Hedoes not want to go to college to continue training. Histeachers and family are concerned by his failure tounderstand the likely consequences of this.Anselm Eldergill 16. Autonomy and capacity An individual who isable to understandand retain theinformation relevantto the decision isnevertheless stillincapacitated if s/heis unable to make adecision based onthat information.Examplesome people may be unableto exert their will becauseof delusions or compulsions or[some] other reasonconnected with theirdisability. The schizophrenicwho cannot believe what hisdoctors tell him is oneexample. (Who Decides,p.13). 17. 4 STATUTORY PRINCIPLES 18. Statutory principles2013 Bill 2005 Act1 8.(2) It shall be presumed that a [person whosecapacity is being called into question or may shortly becalled into question ] has capacity in respect of thematter concerned unless the contrary is shown inaccordance with the provisions of this Act.Same2 8.(3) A [person whose capacity is being called intoquestion or may shortly be called into question ] shallnot be considered as unable to make a decision inrespect of the matter concerned unless all practicablesteps have been taken, without success, to help him orher to do so.Same3 8.(4) A [person whose capacity is being called intoquestion or may shortly be called into question ] shallnot be considered as unable to make a decision inrespect of the matter concerned merely by reason ofmaking, having made, or being likely to make, anunwise decision.Same 19. Statutory principles2013 Bill 2005 Act4 8.(5) There shall be no intervention inrespect of a relevant person unless it isnecessary to do so having regard to theindividual circumstances of the relevantperson [RP].AAnn aacctt ddoonnee,, oorr ddeecciissiioonnmmaaddee,, uunnddeerr tthhee AAcctt ffoorr oorroonn bbeehhaallff ooff aa ppeerrssoonn wwhhoollaacckkss ccaappaacciittyy mmuusstt bbeeddoonnee,, oorr mmaaddee,, iinn hhiiss bbeessttiinntteerreessttss..5 8.(6) An intervention in respect of arelevant person shall(a) be made in a manner that minimises(i) the restriction of the RPs rights, and(ii) the restriction of the RPs freedom ofaction, and(b) have due regard to the need to respectthe right of the RP to his or her dignity,bodily integrity, privacy and autonomy.BBeeffoorree tthhee aacctt iiss ddoonnee,, oorrtthhee ddeecciissiioonn iiss mmaaddee,,rreeggaarrdd mmuusstt bbee hhaadd ttoowwhheetthheerr tthhee ppuurrppoossee ffoorrwwhhiicchh iitt iiss nneeeeddeedd ccaannbbee aass eeffffeeccttiivveellyy aacchhiieevveeddiinn aa wwaayy tthhaatt iiss lleessssrreessttrriiccttiivvee ooff tthhee ppeerrssoonnssrriigghhttss aanndd ffrreeeeddoomm ooffaaccttiioonn..Anselm Eldergill 20. Wishes, beliefs and feelings2013 Bill 2005 Act8.(7) The intervener, in making an intervention inrespect of a relevant person, shall (b) give effect, in so far as is practicable, to the pastand present will and preferences of the relevantperson, in so far as that will and those preferences arereasonably ascertainable,(c) take into account(i) the beliefs and values of the relevant person (inparticular those expressed in writing), in so far asthose beliefs and values are reasonably ascertainable,and(ii) any other factors which the relevant person wouldbe likely to consider if he or she were able to do so, inso far as those other factors are reasonablyascertainableThe person determining what isin the individuals best interestsmust consider all the relevantcircumstances and, inparticular, must Consider, so far as isreasonably ascertainable, thepersons past and presentwishes and feelings (and, inparticular, any relevant writtenstatement made by him whenhe had capacity); the beliefsand values that would be likelyto influence his decision if hehad capacity; and the otherfactors that he would be likely toconsider if he were able to doso. 21. 5 STATUTORY MECHANISMS 22. Statutory mechanisms2005 Act Advance decisions (torefuse treatment) Lasting Powers ofAttorney (PW and P&A) Court orders Court appointeddeputies Section 5 (PWinformal)2013 Bill To be inserted in theBill Enduring Powers ofAttorney (PW and P&A) Decision-making order Decision-makingrepresentative order Informal decision-making(PW)=====- Decision-makingassistance agreements- Co-decision-makingagreements and orders 23. 23SScceennaarriioo AAddvvaannccee ddeecciissiioonnMr Smith has suffered from schizophrenia for manyyears. He has been detained on a number ofoccasions. His consultant prescribes him Impotentoxwhen he is acutely unwell. This has very unpleasantside-effects for him. He makes an advance decisionrefusing the treatment in the event he becomesincapacitated. A year later, he relapses and isadmitted to hospital informally. His consultantconsiders that he requires a course of Impotentox

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