No / This paper discusses the early implementation of the Mental Capacity Act 2005 in health and social care in England. The author examines the research evidence to date, particularly monitoring data from the Department of Health, in order to review the progress made in implementation. The extent to which the Act is achieving its overall aim of facilitating decision-making by people lacking capacity is discussed, focusing on people with dementia. The author concludes that the initial implementation of the Act (and the related Deprivation of Liberty Safeguards) has had only limited effectiveness in facilitating decision-making by people lacking capacity, promoting their best interests and protecting their liberty. Future implementation needs to ensure that the rights of people lacking capacity, particularly people with dementia, are taken more seriously in health and social care and are better protected.

Old age – and particularly the increasing numbers of older people globally and within the United Kingdom - is becoming a social and political phenomenon. Yet despite this, very little has been written on how the law – and especially mental disability law – intersects with old age. This is notwithstanding the fact that many older people may encounter conditions that impact their mental or cognitive abilities, and proportionally, may therefore be greatly affected by this area of law. By drawing on a number of theories – sometimes termed ‘relational’ theories – which are derived predominantly from feminist theory, this thesis seeks to explore the adequacy of mental disability law for safeguarding health and welfare-related decision-making of older adults in three areas; where an older person has been subjected to ageism, where they have been the victim of interpersonal abuse, and where they have dementia and may lack mental capacity. Within this broader goal, this thesis has two specific aims. First, to explicitly critique and challenge the adequacy of the law as it is applied in these circumstances. It is suggested in particular that a deeper analysis of the law in both its previous and current forms betrays the liberal and unduly individualistic roots of the legislative framework. These are roots that are predicated on non-interference, and an idealistic paradigm of the rational, autonomous, and healthy bodied individual. This – it is contended throughout – is an unsuitable philosophy to underpin the law, particularly where the law engages with older adults. Second, this thesis aims to navigate a more suitable pathway within the law as it currently exists. While operating as a tool to critique the legislative framework and its underpinning philosophy, it is argued that the theories drawn upon throughout the thesis also have the potential to highlight how the law could be implemented in such a way so as to emphasise the importance of the realities of the lived experiences of old age, and particularly the experience of ageism, abuse, and dementia. Crucially, it is also suggested that such theories can help the law pay greater attention to the complex web of relationships – both positive and negative; personal and societal – that an older person may find themselves embedded within, and that frequently take on an added significance in old age.

This paper discusses whether current UK social policy promotes the human rights of people with dementia living in England. The author focuses on the role of recent legal reforms and key developments in social care policy--notably the Mental Capacity Act 2005 and the 2009 National Dementia Strategy--in facilitating their human rights to liberty and self-determination, particularly a right to choose to live at home. The extent to which the National Dementia Strategy provides access to services and support which provide an alternative to institutional care is critiqued. Whilst recent legislative change has endorsed the rights of people with dementia to liberty and self-determination, it is suggested there is a lack of commitment in government policy more generally to providing access to social care to enable people with dementia to exercise these human rights.

本研究以民國97年5月23日總統公布民法總則編修正條文第14條、15條，增訂第15條之1及第15條之2，民法親屬編第4章監護與輔助制度之新規定，以及法院實務運作為探討重心，輔以分析比較大陸法系國家--德國成年照護制度與日本成年後見制度，以及英美法系國家--英國2005年意思能力法案與美國2006年統一代理權授與授權法之制度，以針對我國學者對於新成年監護制度之見解與目前實務運作所產生之問題為之探討，以提出以下結論與建議：一、基於尊重本人自主權之理念，未來應制定意定監護制度。二、法定監護制度之修正：(1)意思能力之判斷原則應有明確規範，並以英國2005年意思能力法五項指導原則為判斷守則。(2)不應一律剝奪受監護宣告人之行為能力。(3)監護聲請權人應增列未成年監護人、同居人與同性生活伴侶。(4)受破產宣告之人雖不可為財產管理之監護人，但可為身上照護之監護人。(5)監護事務方面，關於重大醫療照護等身上監護事項應明文規定交由法院審查。(6)受監護人之自主權與保護受監護人之利益應有所平衡。(7)建議增列繼任監護人，以及解決監護關係相對終了，因監護人無繼承人時，無人管理受監護人財產移交與結算事項等問題。(8)輔助宣告方面：因輔助人只有同意權無代理權可代受輔助人行使所物返還請求權，為保護受輔助人，可由法院賦予輔助人行使特定財產行為之代理權。(9)最佳利益原則：法院應鼓勵受監護人參與監護事務之決定，並考量受監護宣告之人過去、現在願望與感受，以及受監護宣告之人之價值觀和信仰如何影響其決定，亦即受監護人即便現在欠缺意思能力，其意見仍應予以尊重。三、監護監督制度是監護制度成功與否之重要機制，鑒於國外成年監護制度均設有監護監督機構，以支援法院為監護監督工作，又考量監護品質之維護，我國未來應設立協助法院監督之機關。 / This research is intended to study the amendments of Civil Code, Article 14, Article 15, Article 15-1, Article 15-2, and Section 2 Guardianship and Assistantship over Adults of Chapter IV announced by the President on May 23, 2008, and to investigate the adult guardianship cases. Furthermore, this research chooses four advanced countries--Germany, Japan, the United Kingdom and the United States to compare and analyze their legal systems of adult guardianship. Those countries’ adult guardianship legal systems and the scholars’ viewpoint provide the following conclusions and suggestions: First, according to the underlying philosophy of respecting decision-making power of the ward, we should establish the voluntarily nominated guardian model. Secondly, the Adult Guardianship Act should be amended：(1) A definite standard for a person’s capacity of evaluation should be clarified. We can adopt the UK Mental Capacity Act 2005, the five statutory principles to help evaluate if a person lacks capacity. (2) The Act should not deprive a person of all his legal capacity, when once a person is declared incapacity by the family court. (3) The Act’s applicants should include minor guardian and civil partnership. (4) Guardians who are bankrupt will no longer be allowed to act as guardians for property and affairs but can still act as guardians for personal welfare. (5) The ward’s personal welfare decisions on serious healthcare and treatment should be put before the family court for approval. (6) The act should aim to balance an individual’s right to make decisions for themselves with their right to be protected from harm if they lack capacity to make decisions to protect themselves. (7) The guardian’s authority terminates when the guardian dies. However, a problem will arise from it. The problem is that if the guardian does not have a successor, the guardian cannot transfer the ward’s property to a new guardian. To solve the problem, adopting a successor guardian may be a good method. (8)The assistance (advisory) system：Because assistants do not have authority to take actions to ask the third person to give back the person’s property, the authority should be granted to assistants by the family court in order to protect their interests. (9) Best interests: The family court must consider the ward’s past and present wishes, feelings, beliefs and values that would be likely to influence his/her decision if he or she had capacity. Thirdly, monitoring guardian system can help adult guardianship system to operate successfully, and protect those wards. Many countries such as Germany, Japan, the United Kingdom and the United States are all devoted to developing their monitoring guardian system. In taking the quality of the adult guardianship into consideration, our country should establish monitoring guardian system in the future.