Search results

Health professionals are in an ethical dilemma. The patients should be assumed as competent. Involuntary treatment is a violation of human rights. Therefore incompetent patients should be protected. However, one cannot determine a patient's incompetency without testing him/her, which is a violation of the assumption of competency. Thus, we propose two different types of uses for competency tests. One is to measure the appropriateness of information disclosed,but with a poor test result the information should be repeated. Another is to measure the competency of the patients when making major decisions. A poor test result will be followed by the designation of a proxy so that incompetent patients can be protected.

Sex offenders who refuse a place on a sex offender treatment programme are estimated to make up about half the prison sex offender population in England and Wales. It is important to motivate refusers to participate in treatment to reduce the likelihood of their re‐offending. In this pilot study we used the Personal Concerns Inventory‐Offender Adaptation (PCI‐OA), a semi‐structured motivational assessment, further adapting it for treatment refusers. We examined the effectiveness of the PCI‐OA (TR) with nine prisoners who had refused sex offender treatment (the treatment group) compared with nine refusers who received no intervention (the control group). The treatment group were at least 0.6 times as likely to show a positive motivational shift towards sex offender treatment as the untreated group. The practice implications of these results are discussed, and further evaluation of the PCI‐OA (TR) is recommended.

In the quest to maximize treatment gains, recent research has shifted focus from treatment itself to the context in which treatment takes place. Such investigations have alluded to rehabilitative climate, therapeutic alliance, prison social climate, and the efficacy of group process. The purpose of this paper is to review peer-support as a mechanism via which these goals might be reached.

A review of the literature on peer-support in carceral settings was undertaken in February 2017.

While there is very little research exploring peer-support in the context of offender rehabilitation, there are some promising signs from many qualitative investigations that peer-led roles can bridge many gaps in support within the therapeutic context.

More research on the potential negative impact of peer-support in carceral setting is needed.

This paper proposes that the implementation of peer-support programs that operate alongside treatment interventions represent an encouraging direction for the future. It is argued that prisoner-led peer-support initiatives that are characterized by shared problem solving and reciprocal emotional support can greatly reduce the anxiety prisoners face surrounding treatment. It is suggested that, through peer-support, treatment gains may be enhanced and better assimilated into program-completers’ lives.

Peer-support may assist current treatment approaches with sexual offenders and could therefore potentially contribute to reductions in recidivism.

This paper is the first to review peer-support in the context of imprisonment and offender therapy. It therefore provides an important status update for future researchers wishing to investigate this topic, and outlines several priorities that such research might interrogate further.

The purpose of this paper is to examine the potential biases in research designs used to assess the efficacy of sex offender treatment.

In all, 50 treatment studies (n=13,886) were examined using a random effects meta-analysis model.

Results indicated a positive effect of treatment for both sexual (OR=0.58, 95%, CI 0.45-0.74, p < 0.0001), and general recidivism (OR=0.54, 95%, CI 0.42-0.69, p < 0.0001), indicating that the likelihood of being reconvicted after treatment was around half compared to no treatment. RCTs showed no significant effect for sexual or general, recidivism. Significant effects were found for non-RCT designs (i.e. incidental cohort, completers vs non-completers designs). Assignment based on need (i.e. giving treatment to those who were high-risk) indicated a negative effect of treatment.

The results highlight the importance of considering study design when considering treatment efficacy.

The current research reports studies identified up until 2009, and examined both published, and unpublished, research originating from a variety of samples employing a random effects model. Consequently, it can be argued that the results are both original and are reflective not only of identified studies, but are also representative of a random set of observations drawn from the common population distribution (Fleiss, 1993). The results of the study suggest that what is required in future research is methodological rigour, and consistency, in the way in which researchers measure the effectiveness of sexual offender treatment.

Assessing the capacity of individuals with learning disabilities to make decisions about treatment is problematic. This field has received little attention in the United Kingdom, the concept of capacity proving difficult to define. There are no commonly agreed standards, English law in this area is still developing and there are few guidelines to instruct health professionals. This paper reviews the diagnostic, outcome and functional approaches to examining the issue of capacity and outlines a number of tests that have been developed for use in the clinical setting, though not adapted for use with people with a learning disability. Issues to be addressed in the adaptation of tests are explored and areas for practitioners to consider are discussed.

The purpose of this paper is to introduce Advance Decisions, address low uptake and examine fundamental issues that can inform the development of policy and practice in this area.

This paper discusses findings from a research project with the charity Compassion in Dying (analysing calls to its telephone helpline) and practical experience of working with the charity Advance Decisions Assistance (helping people write Advance Decisions and training healthcare professionals).

Older people themselves identify the issues of autonomy, identity and efficacy as key challenges in writing Advance Decisions and having them respected.

This paper shows how addressing the “real world” challenges of advance decision making can inform policy and practice.

This paper aims to examine advance decisions to refuse treatment (ADRTs) in the context of the COVID-19 (Coronavirus 2019) pandemic. This study considers the development of ADRTs, the lack of take up and confusion among the general public, clinicians and health and social care staff.

The paper is a conceptual piece that reflects on ADRTs in the particular context of COVID-19. It considers professional concerns and pronouncements on ADRTs.

ADRTs have a low take up currently. There is misunderstanding among public and professionals. There is a need for raising awareness, developing practice and a need to allay fears of misuse and abuse of ADRTs in clinical, health and social care settings.

The authors make recommendations that reflexive training and awareness become the norm in health and social care, that reform of ADRTs is undertaken to prevent misunderstandings and that the person becomes central in all decision-making processes.

This paper is original in considering ADRTs as a safeguarding issue from two perspectives: that of the person making the ADRT and being confident in respect for the decisions made; and that of clinicians and other professionals being reflexively aware of the need to accept advance decisions and not acting according to unconscious biases in times of crisis.

The purpose of this paper is to specifically analyse whether parents should have the legal authority to authorise a deprivation of liberty for children with a learning disability. As a result of parental consent being recognised as holding legal authority, these children have their right to liberty under Article 5 engaged. It will be argued that the courts’ failure to support this view stems from the confusing concept of the “zone of parental control”.

A doctrinal methodology is used, examining domestic law and the European Convention on Human Rights (ECHR), with analysis of relevant literature.

Decisions regarding deprivation of liberty in children under the age of 16 should undoubtedly include parental consent. The concern expressed here is the sovereignty of parental consent over all else. The law is confusing. In one respect rights under the ECHR are universal. However, both UK and European courts have accepted the premise that it is entirely within the zone of parental control to effectively deprive a child of liberty without procedural or judicial review. Furthermore, there are wider potential issues for children being considered to be deprived of liberty following Cheshire West.

The paper is a discussion piece that is critical of the existing law and uses the literature and original opinions to recommend an alternative approach.