TheMental Capacity Act 2005: promoting the citizenship of people with dementia?

Abstract

The Mental Capacity Act 2005 came into force in England and Wales during 2007. The Act enshrines a legal right to autonomy (negative and positive) of people lacking decision-making capacity, such as people with dementia. This paper examines the extent to which the legislation promotes the social citizenship of people with dementia, focusing on its effectiveness in protecting liberty and promoting self-determination and in providing social rights to facilitate autonomy. In particular, the author considers the degree to which the Act will facilitate decision-making by people with dementia, centring on decisions relating to where to live (at home or in an institution). In addition, the historical detention (usually informal) of people with dementia in institutional care, and the role of the Act in promoting recognition of their right to liberty, is highlighted. However, the author points out that the civil rights to liberty and self-determination accorded under the Act--particularly the right to decide where to live--are restricted rights only, as the views of the person lacking capacity can be over-ridden by the decisions of others. In addition, the facilitation of these civil rights is constrained by a lack of access to social rights, particularly the availability of domiciliary and community services to avoid institutional admission. Consequently, whilst the legislation promotes the social citizenship of people with dementia, it has limited capacity to facilitate their full citizenship status.

A qualitative metasynthesis

“…Particularly in nursing literature, focus has been placed on the care recipient's role in care planning and decision making in residential, hospital, or community settings 1,2 . This discussion has been extended to people with dementia, centring on notions of personhood, citizenship, and the importance of autonomy and choice 3,4,5 .…”

Ethical issues for older people in the emergency department

“…The MCA proposed that individuals lacking mental capacity should be enabled to exercise their extant (or remaining) decision-making capacity (5). This legal definition does not give specific measures of an individual's ability to comprehend information.…”

‘Can't cook, won't cook’: men's involvement in cooking when their wives develop dementia

“…Prior to this law, family members and professionals often made decisions on behalf of people with dementia without regard for their capacity, thereby depriving them of decisional autonomy (Collopy 1995, Boyle 2008. Indeed, previous research into decision-making in dementia only examined the views of family members (Hicks andLam 1999, Adams 2006).…”

“…In addition, women with dementia who could still cook were constrained by their husbands from using their extant decisional and executional capacity (see Collopy 1995). Yet, it should be noted that 'assisted autonomy' is necessary to promote the agency of people with dementia (Boyle 2008). Although Sabat (2003, p. 85) had suggested that people with dementia are susceptible to 'malignant positioning' by others which can undermine their sense of social competency, it is important to note that, at times, this negative positioning may be explained more by gender inequality than by -what Ward et al (2008) referred to as -'cognitive disablism'.…”