brain injury frontal lobe damage - abil · 2019-07-03 · structure • mha (1983) • the...
TRANSCRIPT
![Page 1: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/1.jpg)
BrainInjuryFrontalLobeDamage
andMentalCapacity
DrNeilBrooksRehabWithoutWalls
PresentaAontoABILmeeAnginLondonon19.3.19
![Page 2: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/2.jpg)
Structure
• MHA(1983)
• The“frontal”paAent• BacktobasicsreMCA(2005)(assumpAonofcapacity,
minimallyrestricAve,righttomakefoolishdecisionsetc.)
• Caselaw(LoughlinvSingh,2013;EXBvFDZ,2018)– Effectsoffrontalbraindamage
– Capacitouswithsupport(ornot)– Judge’suseoflayevidence
• Somecases
March25,19 DrNeilBrooks,RehabWithoutWalls 2
![Page 3: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/3.jpg)
MHA(1983)
• Beinga“PaAent”• DiscussedextensivelyinMasterman-ListervBru\on&Co
(1989)
• A"paAent",withinthemeaningofsecAon94(2)oftheMentalHealthAct1983,isapersonwho"isincapablebyreasonofmentaldisorderofmanagingandadministeringhispropertyandaffairs."
• Itwasallornone
March25,19 DrNeilBrooks,RehabWithoutWalls 3
![Page 4: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/4.jpg)
The“frontal”paAent
March25,19 DrNeilBrooks,RehabWithoutWalls 4
![Page 5: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/5.jpg)
March25,19 DrNeilBrooks,RehabWithoutWalls 5
![Page 6: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/6.jpg)
March25,19 DrNeilBrooks,RehabWithoutWalls 6
![Page 7: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/7.jpg)
March25,19 DrNeilBrooks,RehabWithoutWalls 7
![Page 8: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/8.jpg)
FrontalLobeDamage
Changesin:– MoAvaAon– EmoAon– Behaviour– CogniAon
March25,19 DrNeilBrooks,RehabWithoutWalls 8
![Page 9: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/9.jpg)
FrontalLobeSyndrome1
CogniAveimpairments:
• Planning• Problem-solving• IniAaAve• Strategyshicing• Judgement• Abstractreasoning• A\enAon• IQandmostmemoryfuncAonsUSUALLYPRESERVED
March25,19 DrNeilBrooks,RehabWithoutWalls 9
![Page 10: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/10.jpg)
FrontalLobeSyndrome2
MoAvaAonalandBehaviouralChanges
• Apathy,IniAaAve,MoAvaAon• (Usedtobecalled“pseudo-depression”)• DisinhibiAon• ImpulsiveBehaviour • EmoAonallability• Euphoria• IrritabilityandAggression• Indifference• Lackofinsight March25,19 DrNeilBrooks,RehabWithoutWalls 10
![Page 11: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/11.jpg)
FrontalLobeSyndrome3
PersonalityChanges
• Selfcentred• Unfeeling• Inabilitytoseeandunderstandtheneedsofotherpeople• SociallybluntandinsensiAve• (Usedtobecalled“pseudo-psychopathic”)
March25,19 DrNeilBrooks,RehabWithoutWalls 11
![Page 12: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/12.jpg)
FrontalLobeParadox
• ExecuAvefuncAonpreservedintheoffice,butimpairedinreallife
• Theneuropsychexamisconductedatameasuredpace,withfewexternaldistracAons
• Ocen,intellectisunimpaired,butisnotusedflexiblyandadapAvely
• Theabilitytosay,butnottodo• Forexample,seeLoughlinvSingh;EXBvFDZ
March25,19 DrNeilBrooks,RehabWithoutWalls 12
![Page 13: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/13.jpg)
Impactofthesechangesondailylife
• Socialandfamily
• Work• MentalCapacity
March25,19 DrNeilBrooks,RehabWithoutWalls 13
![Page 14: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/14.jpg)
GeneralPrinciples-s.1MCA2005
Apersonmustbeassumedtohavecapacityunlessitisestablishedthathelackscapacity.
ApersonisnottobetreatedasunabletomakeadecisionunlessallpracAcablestepstohelphimtodosohavebeentakenwithoutsuccess.
Apersonisnottobetreatedasunabletomakeadecisionmerelybecausehemakesanunwisedecision.
Anactdone,ordecisionmade,underthisActfororonbehalfofapersonwholackscapacitymustbedone,ormade,inhisbestinterests.
Beforetheactisdone,ordecisionismade,regardmustbehadtowhetherthepurposeforwhichitisneededcanbeaseffecAvelyachievedinawaythatislessrestricAveoftheperson’srightsandfreedomofacAon.
March25,19 DrNeilBrooks,RehabWithoutWalls 14
![Page 15: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/15.jpg)
LackofCapacityFuncAonalandDiagnosAcTest
• S.2(1)ApersonlackscapacityinrelaAontoama\erifatthematerialAmeheisunabletomakeadecisionforhimselfinrelaAontothema\erbecauseofanimpairmentof,ordisturbanceinthefuncAoningofthemindorbrain
– Func:onal:unabletomakeadecisionforhimself…
– Diagnos:c:becauseofanimpairment…– Test:
• Isthereanimpairmentordisturbance?Ifso;• Isthepersonunabletomakeadecision?Ifso;
• IsthisinabilitybecauseoftheidenAfiedimpairmentordisturbance(the“causaAvenexus”)
March25,19 DrNeilBrooks,RehabWithoutWalls 15
![Page 16: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/16.jpg)
FuncAonalTestWhatismeantby“lackofcapacity”?
• S.3(1)ofMCA92005)statesthatPisunabletomakeadecisionforhimselfifatthematerialAme;
• heisunable:– Tounderstandissue-relevantinformaAon;or
– ToretainthatinformaAon;or– TouseorweighthatinformaAonaspartoftheprocessofmakingthedecision;or
– Tocommunicatethedecision(whetherbytalking,usingsignlanguage,oranyothermeans)
March25,19 DrNeilBrooks,RehabWithoutWalls 16
![Page 17: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/17.jpg)
7
02 0
58
1
Fig. 2. Distribution of functional inabilities cited by judge for P’s lack of capacity
Inability to understand
Inability to retain
Inability to use or weigh
Inability to communicate n=0
Ruck Keene et al. Int J of Law & Psychiatry, 2019
March25,19 DrNeilBrooks,RehabWithoutWalls 17
![Page 18: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/18.jpg)
Caselaw
March25,19 DrNeilBrooks,RehabWithoutWalls 18
![Page 19: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/19.jpg)
LoughlinvSingh2013
• SevereTBIinRTAatage12• Damagetothelecfrontallobeofthebrain• MoAvaAon,iniAaAonandorganisaAongreatlyreduced
• IQwellpreservedbutoutsideastructuredsernghestrugglestouAlisehisintelligence
March25,19 DrNeilBrooks,RehabWithoutWalls 19
![Page 20: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/20.jpg)
LoughlinvSingh2013
• “…dysexecuAvesyndromemanifestbypoororganisaAonandplanninganddifficultysustaininga\enAon…
• …impulsivity,disinhibiAon,poorjudgmentandlackofmoAvaAon…
• …parAculardifficultyinweighinguptheconsequencesofhisdecision…appearstooperateverymuchinthepresent…doesn’tseemabletoanAcipatetheconsequencesofhisacAons…”
DrKieranO’Driscoll,ConsultantNeuropsychiatrist
March25,19 DrNeilBrooks,RehabWithoutWalls 20
![Page 21: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/21.jpg)
• TheMCAcriteriaarecogniAve-understand,retain,use/weigh
• EmoAonplaysahugepartindecisionmaking.• KristopherLoughlinhadanimpairedemoAonalunderstanding
oftheworld
• Hecan’tunderstandhowpeoplefuncAon• Hecan’treadsocialcues• “Kristopher–andagainit’sthenatureoftheinjurythathe
hastoknowwhenadviceisappropriate…myconcernisthathemaynotknow…becauseheneedstheinsighttoknowthat…doesn’tappeartoknowwhenheneedstoknow…”
DrKieranO’Driscoll,ConsultantNeuropsychiatrist
March25,19 DrNeilBrooks,RehabWithoutWalls 21
![Page 22: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/22.jpg)
“…he’sverymuchdisadvantagedintermsofhisdecision-makingprocessesastowhattheshort,mediumor,certainly,longtermconsequencesofhisdecisionwouldbe.Theotherproblemis–anditgoesbacktotheemoAonalaspect–thewaytheMentalCapacityActisconstructedgivestheimpressionthatthecogniAveorintellectualsideofthingsisthemostimportant,intermsoflanguage,memoryandraAonalisingyourdecision.But,infact,emoAonplaysaverypowerfulpartinourdecision-making.AndmyimpressionisthatMrLoughlin’semoAonalunderstandingoftheworldandpeoplehasbeenimpaired…”DrKO’Driscoll,ConsultantNeuropsychiatrist
March25,19 DrNeilBrooks,RehabWithoutWalls 22
![Page 23: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/23.jpg)
• “…theconsulAngroom…isanarAficialenvironment…ifyouaskanindividualhowtheywouldbehave,forexample,weretheytoreceivemoneyandtheytellyoutheywouldinvestitinahouse,youhavetotakethatintocontextoftherestofthebehavioursintherealworld…
• …verywellrecognisedthatfolkwithfrontallobebraininjurieswillsayonethinganddoanother…withallthebestintenAons,hemayhavewishedtodosomething,but…couldeasilydotheopposite…”
DrKieranO’Driscoll,ConsultantNeuropsychiatrist
March25,19 DrNeilBrooks,RehabWithoutWalls 23
![Page 24: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/24.jpg)
• Theexpertsweredividedoncapacity• Claimant’sexpertssaidnotcapacitousevenwithsupport• Defendant’sexpertssaidcapacitouswithsupport
March25,19 DrNeilBrooks,RehabWithoutWalls 24
![Page 25: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/25.jpg)
• Thejudgereliedinpartuponlayevidence,parAcularlyaboutdecisionmakingindailylife,withandwithoutsupport
• Thejudgequotedextensivelyfromevidencefromfamilymembers(motherandsister)andcareprofessionals(supportworkerandcasemanager)– “However,Ihavetobearinmindthatthoseworkingincloseand
frequentcontactwiththeClaimantarelikelytohavea“feel”forhiscapacitytomanagehisaffairs…Therefore,Iconclude,notwithstandingthelegalpresumpPoninfavourofcapacity,thattheClaimantdoesnothavecapacitywithintherelevantlegaldefiniPon.”
March25,19 DrNeilBrooks,RehabWithoutWalls 25
![Page 26: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/26.jpg)
EXBvFDZ(2018)
• SevereTBIaged26• “PermanentdifficulAesinexecuAvefuncAoningandin
aspectsofhisbehaviour”
• Lackedcapacitytomanagepropertyandaffairs
• AnissueofwhetherEXBshouldbetoldthesizeofhiscompensaAonaward
• Thejudgeconcluded,“TheClaimantlackscapacitytodecidewhetherornotheshouldknowtheamountoftheSe\lement”
March25,19 DrNeilBrooks,RehabWithoutWalls 26
![Page 27: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/27.jpg)
EXBvFDZ(2018)
• “…basicappreciaAonthatsomeofhiscompensaAonisintendedtopayforhissupportandfutureneeds…
• …whencalm…withintheconfinesofanoffice…andwithsupport,inthatmomenthewouldrecognisepointssuchasthenecessityofanawardlasAngalifeAme…
• …evenifhecouldbesupportedtounderstandsuchconceptsinthecontextofaquietoffice,hesAllwouldnotapplysuchconceptstohiseverydaythinkinganddecisionmaking…”
DrGemmaWall,TreaAngNeuropsychologist
March25,19 DrNeilBrooks,RehabWithoutWalls 27
![Page 28: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/28.jpg)
SomeCases
March25,19 DrNeilBrooks,RehabWithoutWalls 28
![Page 29: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/29.jpg)
DMVeryseverephysicalandcogniAveimpairment
Veryli\leinsight
AskedtoassessCapacity:
– ToliAgate– Makedecisionsregardingwhatcareandsupportarrangements,includingrelevantcarepackagesherequires
– Makeadecisionwhereheresides– Makedecisionsastocontactwithothers
March25,19 DrNeilBrooks,RehabWithoutWalls 29
![Page 30: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/30.jpg)
CapacitytoliAgate
• IdonotknowhowcomplexanyliAgaAonmightbe…
• Nevertheless,giventhenatureandseverityofDM’scogniAveimpairments,coupledwithanextremelackofinsight,IhavetoadvisethecourtthathelackscapacitytoliAgate,evenrathersimpleliAgaAoninvolvingfewandsimpledecisions,andevenwithsupportandadvice
• Ithinkthattheamountofsupportandadvicewouldbesuchthat…decisionswouldbemadeforhim…
March25,19 DrNeilBrooks,RehabWithoutWalls 30
![Page 31: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/31.jpg)
Capacitytomakedecisionsregardingcare…
• DM’scogniAveimpairmentsaresosevere,sopervasive,andwithsuchsignificantdaytodayconsequences,thatIadvisethecourtthatDMlackbothaspectsofcapacity(careandresidence)
• Hecangivesuperficiallyappropriateanswers,butthesearesimple,simplisAc,concreteandoffthepoint…unabletounderstand,retain,anduseorweighinformaAonaboutcare,support,andresidence
March25,19 DrNeilBrooks,RehabWithoutWalls 31
![Page 32: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/32.jpg)
JH
Capacity:
– Tomarry– ToconsenttosexualrelaAonships– ToliAgateproceedingsinrelaAontocapacity
March25,19 DrNeilBrooks,RehabWithoutWalls 32
![Page 33: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/33.jpg)
JH
• Alonghistoryofalcoholabuse,withalcoholicliverdisease• SeveretraumaAcbraininjuryasaresultoffallingoutofbed
whileinalcoholicdetox
• VeryseverecogniAveimpairmentincludingaphasia,andimpairedunderstanding,memory,andproblemsolving
• CurrentlylivinginaLAcarehome• WishestomarryheronandoffalcoholicpartnerPD,who
hasphysicallyabusedherinthepast,abusedstaffinthecarehome,andbroughtalcoholintothecarehome
March25,19 DrNeilBrooks,RehabWithoutWalls 33
![Page 34: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/34.jpg)
JH
• ObviouslylackedcapacitytoliAgate• Hascapacitytomarry(just!)inthecurrentcarehomewhere
decisionmakingissupported,sheiswelllookedacer,andsober,andhasnocontactwithPD
• “…onbalance,JHcurrentlyjustpassesthethresholdforcapacitytomarry…hassomeappreciaAonofthefactthatmarriageisacontractandthatthereare…somemutualreciprocalobligaAonsa\achedtomarriage”
• “…wereJHtoresidewithPDthenthe…supportwouldalmostcertainlynotonlynotbeavailable,butshewouldbeexposedtoundueinfluencefromPD,shewouldconsumelargeamountsofalcohol,and…mentalcapacityinmanyaspectsoflifewoulddiminish,including…capacitytoconsenttomarriage”
March25,19 DrNeilBrooks,RehabWithoutWalls 34
![Page 35: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/35.jpg)
JH
• “…So,onbalance,JHcurrentlyhascapacitytomarry,butwereshetolivewiththepersonshewantstomarry(PD),manyaspectsofmentalcapacity,includingthecapacitytomarrywould,inmyopinion,almostcertainlydisappear,andtherewouldbemajorconcernsaboutJH’sconAnuingwellbeing…”
March25,19 DrNeilBrooks,RehabWithoutWalls 35
![Page 36: Brain Injury Frontal Lobe Damage - ABIL · 2019-07-03 · Structure • MHA (1983) • The “frontal” paent • Back to basics re MCA (2005) (assumpAon of capacity, minimally restricAve,](https://reader033.vdocuments.us/reader033/viewer/2022050507/5f98bdce732e0372573c04d9/html5/thumbnails/36.jpg)
Conclusions
• ExecuAvedysfuncAoncanhaveamajordestabilisingimpactondailylife–includingdecisionmaking,andaspectsofmentalcapacity
• IwelcomedtheMCA(2005)buthavetoconstantlyremindmyselftogobacktothebasicsoftheActandCodeofPracAce
• And,nottoconflatecapacity,vulnerability,andbestinterests• ANDtostartwiththepresumpAonofcapacity
• TheprotecAonimperaAveisever-present
March25,19 DrNeilBrooks,RehabWithoutWalls 36