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Open Access Highly Accessed Research article

Concepts of mental capacity for patients requesting assisted suicide: a qualitative analysis of expert evidence presented to the Commission on Assisted Dying

Annabel Price1*, Ruaidhri McCormack2, Theresa Wiseman3 and Matthew Hotopf4

Author Affiliations

1 Clinical Research Worker in Palliative Care Psychiatry, King’s College London, Institute of Psychiatry, 10 Cutcombe Road, London SE5 9RJ, UK

2 ST3 Academic Clinical Fellow Psychiatry, King’s College London, Institute of Psychiatry London, UK

3 Strategic Lead for Health Service, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK

4 Professor of General Hospital Psychiatry, King’s College London, Institute of Psychiatry London, UK

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BMC Medical Ethics 2014, 15:32  doi:10.1186/1472-6939-15-32

Published: 22 April 2014

Abstract

Background

In May 2013 a new Assisted Dying Bill was tabled in the House of Lords and is currently scheduled for a second reading in May 2014. The Bill was informed by the report of the Commission on Assisted Dying which itself was informed by evidence presented by invited experts.

This study aims to explore how the experts presenting evidence to the Commission on Assisted Dying conceptualised mental capacity for patients requesting assisted suicide and examine these concepts particularly in relation to the principles of the Mental Capacity Act 2005.

Methods

This study was a secondary qualitative analysis of 36 transcripts of oral evidence and 12 pieces of written evidence submitted by invited experts to the Commission on Assisted Dying using a framework approach.

Results

There was agreement on the importance of mental capacity as a central safeguard in proposed assisted dying legislation. Concepts of mental capacity, however, were inconsistent. There was a tendency towards a conceptual and clinical shift toward a presumption of incapacity. This appeared to be based on the belief that assisted suicide should only be open to those with a high degree of mental capacity to make the decision.

The ‘boundaries’ around the definition of mental capacity appeared to be on a continuum between a circumscribed legal ‘cognitive’ definition of capacity (in which most applicants would be found to have capacity unless significantly cognitively impaired) and a more inclusive definition which would take into account wider concepts such as autonomy, rationality, voluntariness and decision specific factors such as motivation for decision making.

Conclusion

Ideas presented to the Commission on Assisted Dying about mental capacity as it relates to assisted suicide were inconsistent and in a number of cases at variance with the principles of the Mental Capacity Act 2005. Further work needs to be done to establish a consensus as to what constitutes capacity for this decision and whether current legal frameworks are able to support clinicians in determining capacity for this group.

Keywords:
Assisted suicide; Mental capacity; Qualitative