International Journal of Law and Psychiatry最新文献

{"title":"Artificial intelligence and mental capacity legislation: Opening Pandora's modem","authors":"Maria Redahan ,&nbsp;Brendan D. Kelly","doi":"10.1016/j.ijlp.2024.101985","DOIUrl":"https://doi.org/10.1016/j.ijlp.2024.101985","url":null,"abstract":"<div><p>People with impaired decision-making capacity enjoy the same rights to access technology as people with full capacity. Our paper looks at realising this right in the specific contexts of artificial intelligence (AI) and mental capacity legislation. Ireland's Assisted Decision-Making (Capacity) Act, 2015 commenced in April 2023 and refers to ‘assistive technology’ within its ‘communication’ criterion for capacity. We explore the potential benefits and risks of AI in assisting communication under this legislation and seek to identify principles or lessons which might be applicable in other jurisdictions. We focus especially on Ireland's provisions for advance healthcare directives because previous research demonstrates that common barriers to advance care planning include (i) lack of knowledge and skills, (ii) fear of starting conversations about advance care planning, and (iii) lack of time. We hypothesise that these barriers might be overcome, at least in part, by using generative AI which is already freely available worldwide. Bodies such as the United Nations have produced guidance about ethical use of AI and these guide our analysis. One of the ethical risks in the current context is that AI would reach beyond communication and start to influence the content of decisions, especially among people with impaired decision-making capacity. For example, when we asked one AI model to ‘Make me an advance healthcare directive’, its initial response did not explicitly suggest content for the directive, but it did suggest topics that might be included, which could be seen as setting an agenda. One possibility for circumventing this and other shortcomings, such as concerns around accuracy of information, is to look to foundational models of AI. With their capabilities to be trained and fine-tuned to downstream tasks, purpose-designed AI models could be adapted to provide education about capacity legislation, facilitate patient and staff interaction, and allow interactive updates by healthcare professionals. These measures could optimise the benefits of AI and minimise risks. Similar efforts have been made to use AI more responsibly in healthcare by training large language models to answer healthcare questions more safely and accurately. We highlight the need for open discussion about optimising the potential of AI while minimising risks in this population.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"94 ","pages":"Article 101985"},"PeriodicalIF":2.3,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252724000347/pdfft?md5=08c86753e77bd95dd0c4da8a2a5354cf&pid=1-s2.0-S0160252724000347-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140348128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The violence profile of male mentally disordered offenders in a high secure unit in Turkiye","authors":"Baris Kilic-Demir,&nbsp;Selma Cilem Kizilpinar,&nbsp;Selim Polat","doi":"10.1016/j.ijlp.2024.101983","DOIUrl":"https://doi.org/10.1016/j.ijlp.2024.101983","url":null,"abstract":"<div><p>Our knowledge of the severity and reoffending is limited for mentally disordered offenders, and studies generally evaluate without separation between different diagnostic groups. It was aimed to determine the general profile of mentally disordered offenders who are inpatients in a high secure psychiatry unit from Turkiye and to evaluate the factors associated with violence profiles among different diagnostic groups. According to the results the schizophrenia patients committed the most severe crimes, and intellectual disability patients had some different features from schizophrenia and bipolar disorder patients. History of substance misuse in the intellectual disability group (<em>p</em> = 0,045) and comorbid antisocial personality disorder in the bipolar disorder group (p = 0,015) were associated with increased crime severity. Substance misuse history, history of substance use during the crime, and the existence of comorbid antisocial personality disorder were associated with increased offenses in each of the three diagnosis groups. Living alone (<em>p</em> = 0,004) and having a suicide history (p= 0,052) were associated with the high number of offenses in the schizophrenia group. This study is the first study that compares three diagnostic groups to involve a large patient group. We believe that clinicians must evaluate these parameters for the violence risk assessment of patients.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"94 ","pages":"Article 101983"},"PeriodicalIF":2.3,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140295986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New technology, psychiatry, and the law: Panic, prudence, possibility","authors":"Brendan D. Kelly","doi":"10.1016/j.ijlp.2024.101984","DOIUrl":"https://doi.org/10.1016/j.ijlp.2024.101984","url":null,"abstract":"<div><p>Throughout human history, all new technology has been met with surprise, anxiety, panic, and – eventually – prudent adoption of certain aspects of specific technological advances. This pattern is evident in the histories of most technologies, ranging from steam power in the nineteenth century, to television in the twentieth century, and – now – ‘artificial intelligence’ (AI) in the twenty-first century. Each generation believes that the technological advances of its era are quantitatively and qualitatively different to those of previous generations, but the underlying phenomenon is the same: the shock of the new, followed by more gradual adjustment to (and of) new technology. These concerns are apparent today in relation to AI, which reflects interesting but incremental advances on existing technologies, rather than stand-alone developments. The usual concerns with all technologies (e.g., that they will replace certain aspects of human function) are, perhaps, more concerning in fields such as mental capacity law, which often applies to people with impaired decision-making capacity who might be especially vulnerable to technologies which appear capable of encroaching disproportionately on decision-making or other areas of core human function. This paper approaches this topic from an historical standpoint, noting both previous technological panics in the past and the possibilities offered by AI today, provided it is approached in a proportionate, prudent, and person-centered way, underpinned by appropriate ethical guidance and active ethical awareness in clinical and legal practice.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"94 ","pages":"Article 101984"},"PeriodicalIF":2.3,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252724000335/pdfft?md5=71715baacf1ce624290e2dd96b2e165a&pid=1-s2.0-S0160252724000335-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140195505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘I was going into it blind’: Nearest Relatives, legal literacy, and the Mental Health Act 1983","authors":"Judy Laing ,&nbsp;Jeremy Dixon ,&nbsp;Kevin Stone","doi":"10.1016/j.ijlp.2024.101981","DOIUrl":"https://doi.org/10.1016/j.ijlp.2024.101981","url":null,"abstract":"<div><p>Eligible relatives are given rights and powers in the compulsory treatment of people with mental health problems in several international jurisdictions, including within England and Wales. However, little attention has been given to whether relatives feel legally literate or competent to fulfil such roles. This article examines this issue through focussing on the experiences of Nearest Relatives, who are given rights and powers during Mental Health Act 1983 (MHA) assessments for compulsory admission in England and Wales. Interviews with nineteen Nearest Relatives in England were conducted and were thematically analysed. Three themes were identified. First, NRs spoke about their awareness and knowledge of the role. They predominantly reported negative experiences in which they received no or little information. They also reported that professionals assumed they possessed legal knowledge, and their legal knowledge was largely self-taught. Secondly, NRs reported uncertainty about their own rights and powers, noting the role lacked status or informational or emotional support. Third, NRs highlighted areas for legal reform, stating that the NR role was important, but required specialist support systems for NRs. The findings of this study indicate greater attention needs to be given by law and policy makers to support relatives' understanding of their rights and powers under the MHA, if the NR role is to be effective in helping to safeguard patient rights under the European Convention on Human Rights. These include the right in Article 5 not to be arbitrarily deprived of one's liberty and the right to a private and family life in Article 8. Legislators also need to take account of these factors when considering proposals to reform mental health law in England and Wales.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"94 ","pages":"Article 101981"},"PeriodicalIF":2.3,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S016025272400030X/pdfft?md5=8d9cc51a5725f844429c8eeee37d1ff5&pid=1-s2.0-S016025272400030X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140181048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persons with mental disorders and assisted dying practices in Spain: In response to Ramos et al.","authors":"Josep Pifarre ,&nbsp;Montse Esquerda ,&nbsp;Francesc Torralba ,&nbsp;Jacinto Bátiz ,&nbsp;Margarita Bofarull","doi":"10.1016/j.ijlp.2024.101980","DOIUrl":"https://doi.org/10.1016/j.ijlp.2024.101980","url":null,"abstract":"<div><p>Ramos et al. paper offers a narrative review of Spanish Organic Law 3/2021, which regulates euthanasia, focusing on its application to individuals with mental disorders. Ramos et al. examine the application of legal prerequisites from an ethical-legal perspective to ascertain the conditions under which psychiatric euthanasia might be considered legitimate and compliant with legal stipulations. Nevertheless, it is apparent that the core ethical inquiries linked to this matter have not been exhaustively investigated. The criteria laid out are, in our assessment, still open to further debate and broader deliberation. Our article emphasizes the need for a comprehensive ethical and legal debate in Spain regarding psychiatric euthanasia. Competency assessment is central to the legislation, but there are concerns about the validity of assessment tools and the subjective nature of interviews. Furthermore, defining irreversible suffering in mental health contexts poses challenges. The article advocates for a deeper understanding of the needs of individuals with mental disorders before considering euthanasia and emphasizes the importance of comprehensive care and psychosocial interventions in reducing the desire for euthanasia. Ultimately, it underscores the ethical complexities of euthanasia in mental health and the necessity of prioritizing comprehensive care in addressing these complexities.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"94 ","pages":"Article 101980"},"PeriodicalIF":2.3,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140138290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult safeguarding legislation: Navigating the borderlands between mental capacity, mental health and social care law and practice","authors":"Kathryn Mackay ,&nbsp;Pearse McCusker","doi":"10.1016/j.ijlp.2024.101964","DOIUrl":"https://doi.org/10.1016/j.ijlp.2024.101964","url":null,"abstract":"<div><p>Adult safeguarding legislation is contentious because it seeks to protect ‘vulnerable’ adults who fall between the borderlands of social care, mental health and mental capacity law. As a new and complex area of law and practice, further research on adult safeguarding legislation is required, in particular to consider it efficacy and human rights implications. Utilising a narrative literature review approach this article explores current research evidence on the Adult Support and Protection (Scotland) Act 2007 to consider whether safeguarding powers and duties can achieve a proportionate balance between individual autonomy and the state's duties to protect adults at risk of harm and, if so, how. The findings demonstrate there is a wide range of people who can fall into these borderland areas. For a majority, the use of the Act has made significant positive differences to their lives. However, while supported decision-making was identified it was not found to be consistently applied. In addition, concerns emerged around the adequacy of some professionals' legal knowledge, the consistent upholding of adults' will and preferences, and the commitment to and resourcing of supported decision-making. Notwithstanding these drawbacks, it is concluded that this Act provides vital functions but amendments would enhance alignment with the CRPD.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"94 ","pages":"Article 101964"},"PeriodicalIF":2.3,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S016025272400013X/pdfft?md5=e07b304e0c2a2928a5d9e148452d4216&pid=1-s2.0-S016025272400013X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140103322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of psychopathology on children credibility of sexual abuse testimony","authors":"María A. García-Rico ,&nbsp;Jorge J. Ricarte ,&nbsp;María V. Jimeno ,&nbsp;José M. Latorre","doi":"10.1016/j.ijlp.2024.101972","DOIUrl":"https://doi.org/10.1016/j.ijlp.2024.101972","url":null,"abstract":"<div><p>When an alleged victim has a pre-existing psychopathological diagnosis, this can affect the rating of their version of the abuse in terms of credibility. The objective of this work is to analyze the relationship between the assessment of the credibility of the testimony of a CSA victim, the psychological problems that the child may have presented prior to sexual abuse and the possible psychological sequelae that she may present as a result of the abuse. 109 cases were selected in which the credibility of the testimony could be determined. Through forensic interviews and the study of the corresponding professional reports, the following were obtained: sociodemographic data, data on their previous psychological state and data on their psychological state after the reported events. The psychological state of the child after the reported events shows no relation to the forensic evaluation of the credibility of her testimony. The existence of a relationship between the absence of previous psychopathology and the fact that the victim's testimony is valued as a credible account is confirmed. This study reveals that children who presented psychological manifestations prior to their experience of abuse receive a lower credibility rating than those without previous psychopathological symptoms or diagnoses.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"94 ","pages":"Article 101972"},"PeriodicalIF":2.3,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252724000219/pdfft?md5=00b168edc59f9534543dd49b32e47463&pid=1-s2.0-S0160252724000219-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140062093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forensic aspects of dissociative positive symptoms in trauma-related disorders and borderline personality disorder","authors":"Stefan Tschoeke ,&nbsp;Tilman Steinert ,&nbsp;Hans Knoblauch","doi":"10.1016/j.ijlp.2024.101973","DOIUrl":"https://doi.org/10.1016/j.ijlp.2024.101973","url":null,"abstract":"<div><p>A psychotically motivated act or an act committed under impaired insight and control of action in the midst of an acute psychosis is the standard for lack of criminal responsibility. There is now increasing evidence that positive symptoms, particularly in the form of hallucinations and delusions, in trauma-related disorders and borderline personality disorder (BPD) are comparable to positive symptoms in psychotic disorders, posing a challenge for differential diagnosis and forensic assessment of the relevance of positive symptoms to insight and self-control. Due to the indistinguishability of the phenomena, there is both a risk of misdiagnosis of a psychotic disorder and also trivialization with the use of <em>pseudo-hallucinations</em> or <em>quasi-psychotic</em> labels. Essential phenomenological differences that may be helpful in forensic assessments are the usually preserved reality testing in trauma-related disorders and BPD, as well as differences in psychopathological symptom constellations. Because of these differences relevant to forensic assessments, it seems useful to distinguish trauma-related disorders and BPD with positive symptoms from psychotic disorders.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"94 ","pages":"Article 101973"},"PeriodicalIF":2.3,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252724000220/pdfft?md5=5527946a1bdce139c3d0afaf60bea446&pid=1-s2.0-S0160252724000220-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140062161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influence of the convention on the rights of persons with disabilities on the European court of human rights in the area of mental health law: Divergence and unexplored potential","authors":"János Fiala-Butora","doi":"10.1016/j.ijlp.2024.101965","DOIUrl":"10.1016/j.ijlp.2024.101965","url":null,"abstract":"<div><p>This article explores how the European Court of Human Rights has applied the norms of the UN Convention on the Rights of Persons with Disabilities (CRPD) in the area of mental health law. The European Court was initially receptive to the CRPD, including the UN Committee on the Rights of Persons with Disabilities' call for a repeal of legislation permitting involuntary psychiatric hospitalisation, but later distanced itself from it. The CRPD has nevertheless influenced how the European Court approached (a) involuntary hospitalisation, (b) separating detention from treatment, (c) restraints and other forms of ill-treatment in institutions, and (d) disability-neutral detention based on disability. Despite the two treaty bodies' different jurisprudential methodology and their different assumptions about the role of medical and legal professionals, the CRPD can continue to influence the European Court in areas such as less restrictive alternatives to coercive treatment, the relevance of capacity, and the importance of personal integrity for mental health treatment.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"94 ","pages":"Article 101965"},"PeriodicalIF":2.3,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252724000141/pdfft?md5=6f0a197fd045e423d0b57e68d6ecb7da&pid=1-s2.0-S0160252724000141-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Evaluation of testamentary capacity: A systematic review’","authors":"Himaja Aravind ,&nbsp;Mark Taylor ,&nbsp;Neeraj Gill","doi":"10.1016/j.ijlp.2024.101969","DOIUrl":"https://doi.org/10.1016/j.ijlp.2024.101969","url":null,"abstract":"<div><h3>Objective</h3><p>To systematically review the literature on methods for the standardized and objective assessment of Testamentary Capacity (TC), to identify the best evidence-based and clinically pragmatic method to assess TC. Doubts concerning TC can have far-reaching legal and financial implications.</p></div><div><h3>Method</h3><p>A systematic search of the literature was conducted, using PRISMA guidelines, to identify studies which describe methods or tools for the assessment of TC.</p></div><div><h3>Results</h3><p>The Testamentary Definition Scale (TDS); the Testamentary Capacity Assessment Tool (TCAT); and the Testamentary Capacity Instrument (TCI) all have good psychometric properties, but TDS only partially assesses TC, and the TCI is designed for research rather than day-to-day clinical practice.</p></div><div><h3>Conclusion</h3><p>The TCAT could usefully supplement the clinical assessment of TC, coupled with a standardized examination of cognition. There is room to develop an all-encompassing TC assessment tool. Currently, the clinical judgement of a medical professional, taking account of the medical, legal, ethical issues informing a capacity or competency decision, remains the gold standard for assessing TC.</p></div>","PeriodicalId":47930,"journal":{"name":"International Journal of Law and Psychiatry","volume":"93 ","pages":"Article 101969"},"PeriodicalIF":2.3,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0160252724000189/pdfft?md5=7b7f5d9a530f226e26a2a56cabaf8ca2&pid=1-s2.0-S0160252724000189-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139992912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}