Is decision-making capacity (DMC) a variable considered when deciding on coercive psychiatric care in your country?

OK so situation in Poland:

Legally -> the law does not use the term DMC, it does in a few places speak of persons incapable of giving consent (the term competence or capacity is somewhat present in legal literature though). Involuntary hospitalisation and treatment is limited to:

persons who are directly endangering life and health of others
persons who are directly endangering their own life (but not health!)
persons whose mental health is expected to deteriorate significantly without admision to the hospital
persons who are incapable of caring for themselves and there is justified expectation that they will benefit from psychiatric treatment

In each case it is subject to judicial review by family court. Also voluntary admission of incompetent patient is subject to such review (e.g. person who is already legally incapacitated).

First two reasons are problematic as the law sets the requirement for the person to be mentally disordered (the wording goes - "because of mental disorders"). Now there is whole lot of philosophy here - cause and effect, theories of mental health etc.

There is also special law for sex offenders who completed their jail terms, but are judged by expert opinion to be still dangerous. I am personally of a opinion it's unconstitutional and violation of multiple international treaties, but it's of minor significance as it only targets something like 2 persons in the whole country at this time.

Practice -> I am not a practitioner but I know a bit of anecdotal evidence and some publications in Polish, I am however not aware of any large scale systematic academic review (there has been some research by state authorities into this over the years). There are significant issues with the system.

Research done in 1990's showed that most physicians think that all mental patients are incompetent. This attitude is slow to change.

There is significant pressure on psychiatrists to judge certain patients dangerous to somehow "relieve" the justice system of them.

It is quite hard to acquire legal incapacitation of senile or demented family members (I have had the experience myself) due to general obstruction of legal system so it is tempting to use the involuntary admission system to expedite the process. At the same time it is quite hard to get medical help for dementia patients if they are peaceful but refuse treatment even if they are completely incapable of caring for themselves.

This is what I can think of right now regarding the practise but I am sure I'd find something more if I look through papers and notes if you need more.

Jakub Zawiła-Niedźwiecki

I am actually quite conflicted on this myself. I think that autonomy is slightly overrated overall in biomedical ethics, but if you press me to give you structured argument why I won't, at least not yet. Still DMC is a significant problem and I think much of it is actually not empirical but philosophical - we are using wrong concepts, that are inadequate, comfortable fictions about human agency and rationality instead of facts and so on. I hope to contribute a tiny bit to this area in next couple of years.

Criminal responsibility and decisionmaking capacity - any suggestions on papers?

No title

Is it possible to apply the concept of self-defense to the subjective pre-requisite for criminal responsibility?

Mental illness: equivalent with brain disorder?

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