Literature Review on Provision of Appropriate and Accessible ...

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itself indicate incompetence. Similarly, fear can affect a person’s ability
to make a decision, but it is important to look behind the response and to
assess the individual. A person may decline a procedure, as they believe
it will be very <strong>Literature</strong> painful and <strong>Review</strong> they on do Provision not want of Appropriate to experience and that Accessible pain. But
it may be the Support case, that to People with with careful an Intellectual explanation Disability about the who procedure are
and with options Experiencing for pain Crisis relief, Pregnancy his or her fears may be allayed, and
thus they can consent to the treatment. Other temporary factors such as
shock, drugs and confusion may also impinge on someone’s competence
(Hobden and Mills, 2008).
Donnelly (2007) emphasises the need for a rigorous approach to expert
evidence (i.e. evidence from the medical profession) and a participative
element when formally assessing capacity. She discusses the problems
which can arise with the quality of expert evidence (due in part to
a general lack of awareness of the legal position among medical
professionals), such as for example, adopting a status approach where
the expert gives evidence that the individual has a mental condition
such as schizophrenia and then concludes on this basis that he/she is
incapable rather than applying the legal test for capacity (Grisso, 2002).
In addition, a participative element in the process by the individual
concerned will lead to better decision-making and will also assist in
minimising the negative impact of the process on the individual involved
(Donnelly, 2007). The 2005 Guidelines include key points in relation to the
assessment of capacity [47] as follows:
1. People with intellectual disabilities are not a separate group
of human beings who think, feel and act in a similar fashion.
Their individual likes, dislikes, choices, talents, strengths and
weaknesses are varied as elsewhere in society.
2. Difficulties in communication should not be confused with
incapacity.
3. Presence of intellectual disability must not undermine the
presumption of capacity.
47 Adapted from Ontario Ministry of the Attorney General, 2005.