Clin Med
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Mental capacity is required for an adult to make autonomous treatment choices. This review highlights recent legal and clinical developments in the field. The recent English Mental Capacity Act 2005 is described and compared with mental health legislation. ⋯ Such research indicates firstly that capacity can reliably be assessed; secondly, that among general hospital inpatients, approximately one-third may lack capacity; and thirdly, that mental incapacity in this setting is mainly driven by cognitive impairment caused by delirium or dementia. This is contrasted with psychiatric inpatients, where the problem is no more frequent, but mainly relates to psychotic illness. The article finishes with some general guidance as to how to assess mental capacity in the general hospital.
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There is a long history of problems in the relationship between doctors and managers. The reasons for this stem from the values of each group and the effect that these have on their views on a number of key aspects of healthcare and its delivery. ⋯ Both groups have skills and knowledge vital to the other, so each needs to recognise the strengths of the other and find ways to develop a productive partnership. Clinical work can be improved by the application of management techniques, and management would benefit from more clinical leadership.
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Our society is very concerned with endowing and protecting people's rights and the existence of a National Health Service in this country has allowed such concepts to be applied to medical care. It is not clear, however, whether the concept of rights helps either doctors or patients, and it may in fact be misleading or even damaging. ⋯ The way in which rights create corresponding duties and responsibilities, and the particular problems that this creates for our health service is also addressed. Finally, in the light of the ongoing changes in the doctor-patient relationship, the future balance of rights and responsibilities in healthcare and the impact this will have on clinical decision-making is discussed.
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Whilst patients and doctors each bring a collection of rights and responsibilities with them into the consulting room, these parties must not be seen in isolation. The government of the day and its representatives have an absolute right to influence the future direction of the health service but they also have very grave responsibilities.