Interpersonal relationships, especially when connected to problematic or influential individuals, can significantly impact how courts view a person’s capacity to make decisions and, consequently, their rights.
A new study explores how these relationships might lead to concerns about an individual’s ability to preserve independence, restrict their perspective, or cause them to value or overly depend on a relationship. For example, an influential person might unduly sway the decision-making process, or the individual may be in denial about negative aspects of a relationship, leading to questionable decisions.
Researchers from the Mental Health, Ethics and Law Research Group at King’s College London explored the intricate ways that interpersonal relationships influence legal judgments on decision-making capacity. The study was published in the Medical Law Review.
Their insights show that legal assessments of capacity are not made in isolation but are deeply influenced by the context of personal relationships. The article emphasizes the need for more precise guidance and understanding in this area, to ensure that the rights and autonomy of individuals, particularly those with intellectual and psychosocial disabilities, are properly protected and respected in legal proceedings.
The research team, including Kevin Ariyo, Nuala B. Kane, Gareth S. Owen, and Alex Ruck Keene, performed a content analysis on published court judgments that highlighted interpersonal problems as relevant to capacity. Their analysis led to the development of a typology, showcasing five ways the courts view personal relationships as problematic in assessing capacity:
- An individual’s inability to maintain free will or independence
- Restrictions placed on a person’s perspective
- Valuing or dependence on specific relationships
- Acting on general suggestibility to influence
- Denial of facts concerning a relationship
Starting in 2005, with the passage of the Mental Capacity Act (MCA 2005), courts in England and Wales began using a cognitive test defined in the MCA 2005 to assess the decision-making capacity of individuals with intellectual and psychosocial disabilities. According to the MCA 2005, this evaluation relies on “a cognitive test with cognitive processes considered as internal characteristics.” The Act does not mention the influence of external factors, such as interpersonal relationships, on capacity. The objective of the current study was to examine how the courts interpret the role of interpersonal relationships in decision-making capacity.
To achieve this, the researchers conducted a review and content analysis of legal cases in England and Wales involving interpersonal influence and decision-making capacity. They specifically examined cases from the Court of Protection, Court of Appeal, and High Court that reached a decision about an individual’s capacity to make decisions. To qualify for this review, cases had to involve a person over the age of 18 and demonstrate actual influence from a specific influencer. In total, 20 court cases were reviewed, with half involving intellectual disability and the remainder involving various other conditions.
Each case was analyzed for descriptive information (e.g., age, gender, final decision) and qualitative content related to the influence of a specific individual on decision-making capacity. Two researchers coded the content, and any disputes were resolved by a third researcher. In the end, the authors identified 54 instances of interpersonal influence on decision-making capacity.
Of these references, 15 in 8 cases concerned an individual’s inability to maintain independence and free will. For example, authorities were concerned about a young woman named AC living with her boyfriend, who had prior convictions for domestic violence. The court found she lacked the capacity to choose her living situation until her capacity could be re-evaluated in the future.
Another 12 references in 8 cases were about influence restricting a person’s perspective. The case of G, a 94-year-old woman, illustrates how her carers may have financially exploited her and compromised her decision-making. Ultimately, G was found to lack capacity, and the judge cited her carers’ influence as a factor.
In 12 references across 9 cases, individuals were shown to value or depend on a relationship, often to the point of preserving it at all costs. This was commonly seen in marriages, families, and caregiver relationships.
Six references in 5 cases dealt with suggestibility, where an individual’s eagerness to please leads to compliance with others’ demands. For instance, A, a 78-year-old woman, was deemed at risk of exploitation due to her suggestibility.
Another 6 references in 3 cases concerned denial of facts about the influencer or relationship, where individuals refuse to accept negative information. An example includes B, a 31-year-old woman, who lacked the capacity to choose her associates due to denial of an influencer’s history of sexual offences.
The authors note that there is no official guidance on how to handle interpersonal influence in decision-making capacity. Judges vary in their approach, with some distinguishing between influence and capacity, and others finding them intertwined. The issue is complex and a significant concern for professionals assessing capacity.
The study has several limitations, including the pre-COVID-19 data collection, which might not reflect current conditions. Despite being completed in November 2019, the authors believe the review is still relevant. Additionally, the complexity of the data may affect coding reliability, and the focus on cases from England and Wales limits the study’s applicability to other regions. They conclude:
“There is no detailed guidance to suggest how professionals in England and Wales should approach the question of interpersonal influence when assessing capacity. We have undertaken a content analysis to show that interpersonal influence problems are relevant to capacity judgments across a broad range of decisions and impairments. Our typology provides an early framework to begin conceptualizing the different ways in which interpersonal influence problems can be constructed by the courts. This has the potential to improve clarity around the most contested criteria within the functional model, and to better equip the courts to consider possible interactions between mental impairments and influence. ”
Authors have written in the past about the precarious position many people with psychosocial disabilities find themselves in with regard to their legal capacity to make decisions for themselves. The research underscores the importance of non-coercion and supported decision-making for people with reduced capacity. Service users have written about how mental health legislation can dismiss their own experience and be detrimental to their rights.
Ariyo, K., Kane, N. B., Owen, G. S., & Ruck Keene, A. (2023). Interpersonal influences on decision-making capacity: A content analysis of court judgments. Medical Law Review. https://doi.org/10.1093/medlaw/fwad017 (Link)
Editor’s Note: Part of MITUK’s core mission is to present a scientific critique of the existing paradigm of care. Each week we will be republishing Mad in America’s latest blog on the evidence supporting the need for radical change.