OBJECTIVES:To examine attitudes to the Mental Capacity Act's new statutory Independent Mental Capacity Advocate (IMCA) service in England and Wales and consider the implications for its delivery. METHODS:Quantitative data describing all referrals to the seven pilot IMCA services (January 2006-March 2007) and qualitative data from semi-structured interviews with 18 doctors, 21 senior nurses and one discharge planning manager in four general hospitals in England. RESULTS:Of 127 hospital-based referrals to the seven pilot IMCA services, 29 (23%) were for patients facing serious medical treatments, 52% of whom were judged to lack decision-making capacity due to a learning disability; ninety-eight (77%) were for patients facing a change of accommodation upon hospital discharge, 62% of whom were elderly and lacked capacity due to dementia. While aware of the potential benefits of the IMCA service, clinicians were generally negative about the contribution advocates could make to patients' medical care and thought they could only contribute usefully in a minority of ethically complicated decisions. In contrast, they were more positive about the involvement of advocates in hospital discharge decisions and hoped that they would improve current discharge practice. CONCLUSIONS:Clinicians held ambivalent attitudes towards the involvement of a statutory IMCA service in medical decisions, reflecting beliefs that the service was largely impractical and unnecessary given current procedures for making medical decisions in patients' 'best interests'. Conversely, clinicians were more likely to support advocacy in discharge decisions because they believed that non-medically qualified advocates could make a valuable contribution to decisions that were seen as predominantly social and where practice was frequently considered deficient. By holding these beliefs, clinicians are failing to have due regard for the IMCA service as a statutory measure for safeguarding patients' interests.

译文

目的:研究对《心理能力法案》在英格兰和威尔士新成立的法定独立心理能力提倡者(IMCA)服务的态度,并考虑对其实施的影响。
方法:定量数据描述了所有转诊给七个IMCA试点服务(2006年1月至2007年3月)的数据,以及来自与英格兰四家综合医院的18位医生,21位高级护士和一位出院计划经理进行的半结构式访谈的定性数据。
结果:在七项IMCA试点服务的127例医院转诊中,有29例(23%)是针对面临严重医疗的患者,其中52%被判定为因学习障碍而缺乏决策能力;百分之九十八(77%)的病人是出院后面临住宿变更的患者,其中62%为老年人且因痴呆症而无能力。在意识到IMCA服务的潜在好处的同时,临床医生通常对倡导者可以对患者的医疗服务做出的贡献持否定态度,并认为他们只能在少数道德上复杂的决定中做出有益的贡献。相反,他们对倡导者参与医院出院决定更为积极,并希望他们能够改善目前的出院实践。
结论:临床医生对将法定IMCA服务纳入医疗决策持矛盾态度,反映出这样一种信念,即鉴于当前为患者“最大利益”做出医疗决策的程序,该服务在很大程度上是不切实际和不必要的。相反,临床医生更有可能支持出院决策方面的倡导,因为他们认为没有医学资历的倡导者可以为那些被认为主要是社会行为且经常被认为缺乏实​​践的决策做出有价值的贡献。抱着这些信念,临床医生就没有适当考虑IMCA服务作为保护患者利益的法定措施。

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