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The purpose of this paper is to examine the dilemma at the heart of nursing care – the striving for empowerment of people in nurses’ care with the responsibility to protect vulnerable adults from harm. In doing so, it argues that in difficult and borderline cases, capacity assessment is complex and ultimately based on a judgment involving interpretation, and welcomes the views of clinicians who have challenged the procedural test of capacity in the Mental Capacity Act (MCA).

It presents an illustrative study of a person with acquired brain injury (ABI) resident in a nursing home, who had been assessed under the MCA and judged to have capacity regarding health and welfare decisions, who subsequently displayed a persistent and impulsive desire to leave the unit without thought of risk and vulnerability to herself, prompting safeguarding concerns, and a reassessment of her capacity.

The paper asserts that supporting people with ABI during capacity assessments, as the MCA decrees, in a very structured way can create a false sense of “capacity”. It maintains that executive impairments in ABI, being difficult to assess in formal settings, are best undertaken over time, in real-life settings, with evidence from third parties. It welcomes the MCA’s desire to protect individual autonomy and avoid undue paternalism, through ensuring people are not deemed to lack capacity simply because they make an unwise decision.

But it goes on to argue that in ABI it is often the fact of unwise decision making that is the prominent factor and main concern, particularly in regard to impulsive decision making. If nurses have to make a judgment as to how unwise decisions made with decision-making capacity are to be distinguished from unwise decisions made without it in people with ABI, then, the author concludes, a major area of difficulty for nurses is ascertaining when the presumption of capacity should be challenged, an area that an updated code of practice needs to clarify.

This paper examines how one group of frontline health workers (nurses) amid coronavirus disease 2019 (COVID-19) pandemic perceive the Government of Ghana (GOG)'s decision to ease the lockdown restrictions when cases were increasing. This paper contributes to the literature on Igor Grossman's concept of wise reasoning and its applicability to COVID-19 management decision-making by political leaders.

The paper employed an exploratory qualitative design. The decision to adopt qualitative method is linked to the paucity of research on wise reasoning, political leadership and COVID-19. The paper draws on qualitative online survey with 42 nurses located in Accra Metropolis, Ghana.

The paper demonstrates that a confluence of research participants perceived the government's act of easing the lockdown restrictions to be in bad faith on account of (1) nonrecognition of different perspectives and viewpoints from stakeholders and interest groups; (2) rising number of cases which naturally make the decision to lift the restriction unwise; (3) concerns about the prioritization of peripheral issues over citizens' health and (4) concerns about limited and robust health facilities and their implications.

The key claims must be assessed against the limitations of the study. First, the study is an exploratory study and, therefore, not intended for a generalization purpose. Second, the research participants are highly educated, and the responses in this study are skewed toward them.

The paper is novel in seeking to explore wise reasoning and political leadership during a global pandemic such as COVID-19. This exploratory study demonstrates that COVID-19, though devastating and causing havoc, presents an opportunity to test Igor Grossmann's wise reasoning framework about decision-making by political leaders. This extends the literature on wise reasoning beyond the discipline of psychology (the fact that all the authors are geographers) and Global North to Global South since the data for this study are gathered in Ghana.

The purpose of this paper is to present the findings of a study considering the application of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). Practitioners from a range of professions were recruited to provide their views of how to respond to a variety of scenarios. GPs, nurses, social workers, physio/occupational therapists and care assistants were recruited to participate.

This study used the Delphi method to elicit participant views and generate consensus of opinion. The Delphi method recommends a large sample for heterogeneous groups, and round one had 98 participants from six different professional groups.

Participants did not respond consistently to the scenarios, but disagreed most significantly when patient decisions conflicted with clinical advice, and when to conduct a capacity assessment. These responses suggest that clinical responses vary significantly between individuals (even within settings or professions), and that the application of Mental Capacity Act (MCA) is complicated and nuanced, requiring time for reflection to avoid paternalistic clinical interventions.

Previous studies have not used a Delphi method to consider the application of MCA/DoLS. Because of this methods focus on developing consensus, it is uniquely suited to considering this practice issue. As a result, these findings present more developed understanding of the complexity and challenges for practitioner responses to some relatively common clinical scenarios, suggesting the need for greater clarity for practitioners.

The study of “wisdom” is a subject normally outside the traditional bounds of management studies. Recent financial scandals and management blunders suggest that the time is ripe to introduce, via management development programs, an introductory study into the nature of “wisdom”, and followed by further study into the nature of “managerial wisdom”. Decisions are being made by people practising management which demonstrate that they do not know how to exercise good judgement, nor do they demonstrate that they have an understanding of what it means to be “wise”. This paper looks at the way philosophers have addressed the topic of wisdom from Greco‐Roman times. It includes references to wisdom in history and literature. The paper summarises some of the ideas and developments of more recent research published in psychology journals. It is an extension of ideas expressed in an earlier paper published in this journal viz. “Philosophy in management: a new trend in management development”. Both these papers suggest that management development studies should include areas of study more akin to the great classical tradition, where education is aimed at developing the “whole person”. An introductory study of “philosophy in management”, and “wisdom” in particular, are seen as two ways of expanding the present offerings in management studies

Support providers have a whole range of legal and professional responsibilities to those to whom they provide services, to their employees and to their co‐workers. However, these responsibilities may be in conflict. Although the need to protect vulnerable service users from harm is important, it should be observed within a framework that protects human rights. This tension is further exacerbated by recognition that some vulnerable people are sometimes incapable of making their own decisions. Providers face the daily challenge of promoting autonomy while protecting the health and well‐being of service users.

The purpose of this paper – written by a practising barrister specialising in the Mental Capacity Act 2005 – is to survey law and practice in England and Wales with a view to sketch out a preliminary answer as to whether it can be said there is, in fact, any legally defensible concept of mental capacity.

Review of case-law in England and Wales and relevant domestic and international law, in particular the Mental Capacity Act 2005 and the Convention on the Rights of Persons with Disabilities (“CRPD”).

It is right, and inescapable, to say that mental capacity is in the eye of the beholder, and will remain so even if we seek to recast our legislative provisions. Rather – and perhaps ironically – the conclusion set out above means that we need to look less at the person being assessed, and more at the person doing the assessing. We also need to further look at the process of assessment so as to ensure that those who are required to carry it out are self-aware and acutely alive to the values and pre-conceptions that they may be bringing to the situation.

It seems to me that it is right, and inescapable, to say that mental capacity is in the eye of the beholder, and will remain so even if we seek to recast our legislative provisions. Absent major developments in neuroscience, it will inescapably remain a concept which requires judgments based on interactions between the assessor and the assessed. But that is not thereby to say that it is an irremediably relative and flawed concept upon which we cannot place any weight. Rather the conclusion set out above means that we need to look less at the person being assessed, and more at the person doing the assessing. We also need further to look at the process of assessment so as to ensure that those who are required to carry it out are self-aware and acutely alive to the values and pre-conceptions that they may be bringing to the situation.

This paper serves as a reflection on the best part of a decade spent grappling with the MCA 2005 in and out of the court room, a decade increasingly informed by and challenged by the requirements of the CRPD.

The purpose of this paper is to evaluate staff knowledge of Mental Capacity Act (MCA) capacity assessments within the Learning Disabilities division of a Mental Health and Learning Disabilities Trust. The limited research available suggests staff knowledge tends to be poor, particularly concerning who is the decision maker.

A 12-item multiple choice questionnaire, which reflects the five core principles of MCA (2005), was developed. Questionnaires were completed by 262 health and social staff members who support people with LD.

Results show high variability of MCA capacity assessment knowledge within the LD division. However, qualified staff and those from health services scored significantly higher across all categories on the questionnaire compared to non-qualified and social care staff, respectively. On average, all staff scored poorly when asked to identify “who is the decision maker?” in a case scenario question.

The main limitation is that we did not collect data on how many previous capacity assessments and discussions each person had been involved with. The findings clearly suggest current methods of training lack efficacy in helping staff apply MCA knowledge to their clinical work.

Compared to past literature, this study utilised a novel and more comprehensive questionnaire. This focused on case scenario questions to assess staff situational judgement. In addition, the findings add to a sparse evidence base that provides a foundation for future research.

A brief review of the first three years of the Mental Capacity Act 2005 that was fully implemented during 2007.

The purpose of this paper is to provide an introduction to The Mental Capacity Act, 2005 will come into force in England and Wales in April 2007.

Provides an overview of the changes that will occur when the Act comes into force.

Preparations are already underway, but as yet there has been no centralised support in the form of standardises templates and documentation to ensure consistency across the NHS. Delay in finalising a Code of Conduct to accompany the Act is also hampering efforts to complete preparations for compliance with the Act. Healthcare organisations have a great number of preparations to make and it is likely that many of them will not have been able to complete them before the Act comes into force.

The value of this paper is in drawing attention to the fact that a crucial aspect of the work ahead is to ensure that staff receive adequate and appropriate training. All healthcare professionals – and doctors in particular – should be familiar with, and understand, the key principles of the Act.

The Deprivation of Liberty Safeguards are an extension to the Mental Capacity Act (2005). They provide protection for those who lack capacity to make a decision about residing in a hospital or care home and require a deprivation of their liberty. The following paper is a summary of the safeguards.