Advice-taking as a bridge between decision neuroscience and mental capacity

Decision making capacity for treatment in psychiatric inpatients: a systematic review and meta-analysis

Decision-making capacity (DMC) among psychiatric inpatients is a pivotal clinical concern. A review by Okai et al. (2007) suggested that most psychiatric inpatients have DMC for treatment, and its assessment is reliable. Nevertheless, the high heterogeneity and mixed results from other studies mean there is considerable uncertainty around this topic. This study aimed to update Okai's research by conducting a systematic review with meta-analysis to address heterogeneity. We performed a systematic search across four databases, yielding 5351 results. We extracted data from 20 eligible studies on adult psychiatric inpatients, covering DMC assessments from 2006 to May 2022. A meta-analysis was conducted on 11 papers, and a quality assessment was performed. The study protocol was registered on PROSPERO (ID: CRD42022330074). The proportion of patients with DMC for treatment varied widely based on treatment setting, the specific decision and assessment methods. Reliable capacity assessment was feasible. The Mini-Mental State Examination (MMSE), Global Assessment of Function (GAF), and Brief Psychiatric Rating Scale (BPRS) predicted clinical judgments of capacity. Schizophrenia and bipolar mania were linked to the highest incapacity rates, while depression and anxiety symptoms were associated with better capacity and insight. Unemployment was the only sociodemographic factor correlated with incapacity. Assessing mental capacity is replicable, with most psychiatric inpatients able to make treatment decisions. However, this capacity varies with admission stage, formal status (involuntary or voluntary), and information provided. The severity of psychopathology is linked to mental capacity, though detailed psychopathological data are limited.

Decision-making in autism: A narrative review

LAY SUMMARY

Many autistic people report difficulties with real-life decision-making. However, when doing decision-making tests in laboratory experiments, autistic people often perform as well or better than non-autistic people. We review previously published studies on autistic people's decision-making, across different types of tests, to understand what type of decision-making is more challenging. To do this, we searched four databases of research papers. We found 104 studies that tested, in total, 2712 autistic and 3189 comparison participants on different decision-making tasks. We found that there were four categories of decision-making tests that were used in these experiments: perceptual (e.g. deciding which image has the most dots); reward learning (e.g. learning which deck of cards gives the best reward); metacognition (e.g. knowing how well you perform or what you want); and value-based (e.g. making a decision based on a choice between two outcomes that differ in value to you). Overall, these studies suggest that autistic and comparison participants tend to perform similarly well at perceptual and reward-learning decisions. However, autistic participants tended to decide differently from comparison participants on metacognition and value-based paradigms. This suggests that autistic people might differ from typically developing controls in how they evaluate their own performance and in how they make decisions based on weighing up the subjective value of two different options. We suggest these reflect more general differences in metacognition, thinking about thinking, in autism.

A computational account of how individuals resolve the dilemma of dirty money

Money can be tainted when it is associated with direct or indirect harm to others. Deciding whether to accept "dirty money" poses a dilemma because money can be used to help others, but accepting dirty money has moral costs. How people resolve the dilemma of dirty money remains unknown. One theory casts the dilemma as a valuation conflict that can be resolved by integrating the costs and benefits of accepting dirty money. Here, we use behavioral experiments and computational modeling to test the valuation conflict account and unveil the cognitive computations employed when deciding whether to accept or reject morally tainted cash. In Study 1, British participants decided whether to accept "dirty" money obtained by inflicting electric shocks on another person (versus "clean" money obtained by shocking oneself). Computational models showed that the source of the money (dirty versus clean) impacted decisions by shifting the relative valuation of the money's positive and negative attributes, rather than imposing a uniform bias on decision-making. Studies 2 and 3 replicate this finding and show that participants were more willing to accept dirty money when the money was directed towards a good cause, and observers judged such decisions to be more praiseworthy than accepting dirty money for one's own profit. Our findings suggest that dirty money can be psychologically "laundered" through charitable activities and have implications for understanding and preventing the social norms that can justify corrupt behavior.

Broad concepts and messy realities: optimising the application of mental capacity criteria

Most jurisdictions require that a mental capacity assessment be conducted using a functional model whose definition includes several abilities. In England and Wales and in increasing number of countries, the law requires a person be able to understand, to retain, to use or weigh relevant information and to communicate one's decision. But interpreting and applying broad and vague criteria, such as the ability 'to use or weigh' to a diverse range of presentations is challenging. By examining actual court judgements of capacity, we previously developed a descriptive typology of justifications (rationales) used in the application of the Mental Capacity Act (MCA) criteria. We here critically optimise this typology by showing how clear definitions-and thus boundaries-between the criteria can be achieved if the 'understanding' criterion is used narrowly and the multiple rationales that fall under the ability to 'use or weigh' are specifically enumerated in practice. Such a typology-aided practice, in theory, could make functional capacity assessments more transparent, accountable, reliable and valid. It may also help to create targeted supports for decision making by the vulnerable. We also discuss how the typology could evolve legally and scientifically, and how it lays the groundwork for clinical research on the abilities enumerated by the MCA.

Contributions of Subjective Well-Being and Good Living to the Contemporary Development of the Notion of Sustainable Human Development

The article analyzes the contributions of the notions of Good Living attributable to epistemologies, traditions, and subjective well-being at work, given the current changes in the working context, to enrich the concept of human development. The article is developed with an analytical-descriptive and synthetic approach, reconstructing the concept of Good Living through a theoretical-economic, ontological, and epistemological comparison and its dimensional axes. Methodologically, a systematic review of human development literature is used in Latin America through the Web of Science (WOS), comparing the UNDP Technical Notes (HDI) with the various approaches to Good Living published between 2010 and 2020. These documents were subjected to semantic contrast, with reference to the various dimensions and positions of human development as a generator of subjective well-being for the configuration of public labor policies. The main findings refer to the disagreement points evidenced in the two-axes dimensions of the Good Living measurement systems (mobility and safety, and cultural satisfaction within territories), an important factor being the sumak kawsay, the concept of Good Living. Sumak is fullness, the sublime, excellent, magnificent, beautiful, superior. Kawsay is life, being. However, it is dynamic, changing, and is not a passive question, and is thus not considered by the different evolutionary changes of the HDI.

The Use of Neuroscience and Psychological Measurement in England's Court of Protection

The 2005 Mental Capacity Act of England and Wales provides a description in statute law of a test determining if a person lacks "mental capacity" to take a particular decision and describes how the "best interests" of such a person should be determined. The Act established a new Court of Protection (CoP) to hear cases related to the Act and to rule on disputes over mental capacity. The court gathers a range of evidence, including reports from clinicians and experts. Human rights organisations and others have raised concerns about the nature of assessments for incapacity, including the role of brain investigations and psychometric tests. Aim: Describe use and interpretation of structured measures of psychological and brain function in CoP cases, to facilitate standardisation and improvement of practices, both in the courtroom and in non-legal settings. Method: Quantitative review of case law using all CoP judgments published until 2019. The judgments (n = 408) were read to generate a subset referring to structured testing (n = 50). These were then examined in detail to extract the nature of the measurements, circumstances of their use and features of interpretation by the court. Results: The 408 judgments contained 146 references to structured measurement of psychological or brain function, spread over 50 cases. 120/146 (82.2%) referred to "impairment of mind or brain," with this being part of assessment for incapacity in 58/146 (39.7%). Measurement referred on 25/146 (17.1%) occasions to "functional decision-making abilities." Structured measures were used most commonly by psychiatrists and psychologists. Psychological measurements comprised 66.4% of measures. Neuroimaging and electrophysiology were presented for diagnostic purposes only. A small number of behavioural measures were used for people with disorders of consciousness. When assessing incapacity, IQ and the Mini-Mental-State Examination were the commonest measures. A standardised measure of mental capacity itself was employed just once. Judges rarely integrated measurements in their capacity determinations. Conclusion: Structured testing of brain and psychological function is used in limited ways in the Court of Protection. Whilst there are challenges in creating measures of capacity, we highlight an opportunity for the neuroscience community to improve objectivity in assessment, inside and outside the courtroom.