Astrachan IM, Keene AR, Kim SYH Questioning our presumptions about the presumption of capacity. J Med Ethics. 2023; 0:1-5

McKenna S, O'Reilly D, Maguire A Childhood contact with social services and risk of suicide or sudden death in young adulthood: identifying hidden risk in a population-wide cohort study. J Epidemiol Community Health. 2023; 0:1-7

The effect of HPV vaccination on the rate of high grade cytology in 25 year old women attending cervical screening in Ireland. 2023.

Developing and Testing an Evaluation Framework for Collaborative Mental Health Services in Primary Care Systems in Latin America. 2023.

Research Roundup

02 December 2023
Volume 34 · Issue 12


George Winter provides an overview of recently published articles that may be of interest to practice nurses. Should you wish to look at any of the papers in more detail, a full reference is provided.

In this ethical consideration of capacity, Astrachan et al (2023) introduce a philosophical aspect which is relevant to many health professionals who deal with patients. The presumption of capacity is central to the contemporary doctrine of decision-making capacity (DMC) that helps protect an individual's autonomy.

However, the presumption of capacity is not necessarily straightforward, and the authors consider possible problems. For instance, we can either assume person P has DMC or it is established that P lacks DMC. Let us consider P, who shows signs of impairment and must decide between treatment options X or Y. P is evaluated to determine whether they have the DMC to decide. During the evaluation, P states that they want X. If we presume that P has DMC, then in principle the evaluation should stop and treatment X begun.

But, in practice, this is never done, and as the authors make clear: ‘There is an important distinction between no longer presuming something is true, which leaves open the possibility that it is true or false, and the conclusion that it is true or false.’ Between these two, the authors suggest, is an important unanswered question about what happens during a capacity evaluation, when it is not yet established whether P does or does not have capacity. This unanswered question is explored by the authors.

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