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Homeward bound or bound for a home? Assessing the capacity of dementia patients to make decisions about hospital discharge: comparing practice with legal standards

Lookup NU author(s): Dr Marie Poole, Professor John Bond, Professor Julian Hughes


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Background: This article stems from a larger projectwhich considers ways of improving assessments of capacity and judgements about best interests in connection with people with dementia admitted to acute hospitals with respect to decisions about place of residence. Aims: Our aim is to comment on how assessments of residence capacity are actually performed on general hospital wards compared with legal standards for the assessment of capacity set out in the Mental Capacity Act, 2005 (MCA). Method: Our findings are grounded in ethnographic ward-based observations and in-depth interviews conducted in three hospital wards, in two hospitals (acute and rehabilitation), within two NHS healthcare trusts in the North of England over a period of nine months between 2008 and 2009. Twenty-nine patient cases were recruited to the study. We also draw from broader conceptions of capacity found in domestic and international legal, medical, ethical and social science literature. Results: Our findings suggest thatwhilst professionals profess to be familiarwith broad legal standards governing the assessment of capacity under the MCA, these standards are not routinely applied in practice in general hospital settings when assessing capacity to decide place of residence on discharge from hospital. We discuss whether the criteria set out in the MCA and the guidance in its Code of Practice are sufficient when assessing residence capacity, given the particular ambiguities and complexities of this capacity. Conclusions: We conclude by suggesting that more specific legal standards are required when assessing capacity in this particular context.

Publication metadata

Author(s): Emmett C, Poole M, Bond J, Hughes JC

Publication type: Article

Publication status: Published

Journal: International Journal of Law and Psychiatry

Year: 2013

Volume: 36

Issue: 1

Pages: 73-82

Print publication date: 24/11/2012

ISSN (print): 0160-2527

ISSN (electronic): 1873-6386

Publisher: Elsevier


DOI: 10.1016/j.ijlp.2012.11.009


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