Literature Review on Provision of Appropriate and Accessible ...

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The British Medical Association and the Law Society (BMA and the Law
Society, 2004) advise that GPs should not rely solely on prior reports
giving an estimated ‘mental age’ but must ensure that a current
assessment is made. They note that statements of a person’s mental age
may be misleading if they do not reflect the person’s experience and the
context for the particular decision.
Support to People with an Intellectual Disability who are
Accessible
and Appropriate of Provision on <strong>Review</strong> <strong>Literature</strong>
Experiencing Crisis Pregnancy
Murphy and Clare (2003: 43) reviewed research that used different
instruments to assess capacity of people with intellectual disabilities,
with mental illness, and with dementia. The review found that the studies
suggested that capacity to consent is likely to depend on at least the
manner in which information is presented and tested, and the complexity
of the task required. Breaking up information into smaller ‘chunks’, using
simpler language, and even non-verbal measures was helpful for people
with intellectual disability.
Other assessment instruments noted in the literature included the
MacArthur Competence Assessment Tool (MacCAT-T), which can be used
in making judgements about capacity in a variety of clinical situations
(Grisso and Appelbaum (1998)).
2.8.5 Who can assess capacity?
The person who assesses an individual’s capacity to make a decision will
usually be the person who is directly concerned with the individual at the
time the decision needs to be made. Capacity assessment can be carried
out by different types of people depending on the circumstances: by the
person caring for them (usually with regard to day-to-day decisions), by a
general practitioner or healthcare professional. More complex decisions
are likely to need more formal assessments. Sometimes there is no
need for any type of formal capacity assessment by a professional before
determining that a person does not have capacity. Sometimes legislation
will determine who is required to assess capacity and sometimes it is set
down in organisational guidelines.
2.8.6 Acting in the person’s ‘best interests’
The effect of a finding that a person lacks capacity to make a particular
decision is that some other person or body will make the decision for