Cargando…

Insight Under Scrutiny in the Court of Protection: A Case Law Survey

The concept of patient insight, of a patient’s self-awareness of illness or impairment (and related issues), plays a significant role in clinical discourse and clinical practice. But what role does it play in the legal process, particularly when a patient’s decision-making capacity (or “mental capac...

Descripción completa

Detalles Bibliográficos
Autores principales: Gurbai, Sándor, Fitton, Emily, Martin, Wayne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518213/
https://www.ncbi.nlm.nih.gov/pubmed/33061918
http://dx.doi.org/10.3389/fpsyt.2020.560329
_version_ 1783587360094552064
author Gurbai, Sándor
Fitton, Emily
Martin, Wayne
author_facet Gurbai, Sándor
Fitton, Emily
Martin, Wayne
author_sort Gurbai, Sándor
collection PubMed
description The concept of patient insight, of a patient’s self-awareness of illness or impairment (and related issues), plays a significant role in clinical discourse and clinical practice. But what role does it play in the legal process, particularly when a patient’s decision-making capacity (or “mental capacity”) is in question? We report on a survey of 412 published judgments from the Court of Protection of England and Wales, published between 2007 and 2018. We found that the notion of patient insight played a role in 53 cases (13% of the total). We use a variety of techniques to provide a systematic profile of these “insight cases.” We provide a demographic profile of the patients whose insight is discussed (focusing on gender, age and diagnosis) and a professional profile of the expert witnesses who raise the issue of insight. We then deploy the technique of “logical geography” to map the meaning of the term insight and the inferential patterns in which reports of patient insight are embedded. We point out that the published insight cases never explicitly define “insight,” and that they include no reference to structured instruments or scales for the assessment of insight. We show that the concept of insight, as used in the Court of Protection, is not synonymous with the concept of agreement with a diagnosis of illness; this is at most one of a range of meanings that the concept carries. We show that, despite the fact that the presence or absence of insight is not itself a legal criterion for mental capacity, insightlessness does play a role, and sometimes a decisive role, in shaping findings as regards the presence or absence of mental capacity. Finally, we assess the extent to which expert testimony in the insight cases conforms to the insight-related recommendation of the recent NICE Guideline on Decision-Making and Mental Capacity.
format Online
Article
Text
id pubmed-7518213
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-75182132020-10-13 Insight Under Scrutiny in the Court of Protection: A Case Law Survey Gurbai, Sándor Fitton, Emily Martin, Wayne Front Psychiatry Psychiatry The concept of patient insight, of a patient’s self-awareness of illness or impairment (and related issues), plays a significant role in clinical discourse and clinical practice. But what role does it play in the legal process, particularly when a patient’s decision-making capacity (or “mental capacity”) is in question? We report on a survey of 412 published judgments from the Court of Protection of England and Wales, published between 2007 and 2018. We found that the notion of patient insight played a role in 53 cases (13% of the total). We use a variety of techniques to provide a systematic profile of these “insight cases.” We provide a demographic profile of the patients whose insight is discussed (focusing on gender, age and diagnosis) and a professional profile of the expert witnesses who raise the issue of insight. We then deploy the technique of “logical geography” to map the meaning of the term insight and the inferential patterns in which reports of patient insight are embedded. We point out that the published insight cases never explicitly define “insight,” and that they include no reference to structured instruments or scales for the assessment of insight. We show that the concept of insight, as used in the Court of Protection, is not synonymous with the concept of agreement with a diagnosis of illness; this is at most one of a range of meanings that the concept carries. We show that, despite the fact that the presence or absence of insight is not itself a legal criterion for mental capacity, insightlessness does play a role, and sometimes a decisive role, in shaping findings as regards the presence or absence of mental capacity. Finally, we assess the extent to which expert testimony in the insight cases conforms to the insight-related recommendation of the recent NICE Guideline on Decision-Making and Mental Capacity. Frontiers Media S.A. 2020-09-11 /pmc/articles/PMC7518213/ /pubmed/33061918 http://dx.doi.org/10.3389/fpsyt.2020.560329 Text en Copyright © 2020 Gurbai, Fitton and Martin http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Gurbai, Sándor
Fitton, Emily
Martin, Wayne
Insight Under Scrutiny in the Court of Protection: A Case Law Survey
title Insight Under Scrutiny in the Court of Protection: A Case Law Survey
title_full Insight Under Scrutiny in the Court of Protection: A Case Law Survey
title_fullStr Insight Under Scrutiny in the Court of Protection: A Case Law Survey
title_full_unstemmed Insight Under Scrutiny in the Court of Protection: A Case Law Survey
title_short Insight Under Scrutiny in the Court of Protection: A Case Law Survey
title_sort insight under scrutiny in the court of protection: a case law survey
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518213/
https://www.ncbi.nlm.nih.gov/pubmed/33061918
http://dx.doi.org/10.3389/fpsyt.2020.560329
work_keys_str_mv AT gurbaisandor insightunderscrutinyinthecourtofprotectionacaselawsurvey
AT fittonemily insightunderscrutinyinthecourtofprotectionacaselawsurvey
AT martinwayne insightunderscrutinyinthecourtofprotectionacaselawsurvey