Alec Buchanan

..The article compares two approaches to "proportionality." The conclusions have implications for the wording of examiners' conclusions and for the criteria by which patients are regarded as "restored to competence."..

..Providing statistical data can only be part of establishing the precision of an estimate of the probability of someone acting violently. Copyright © 2012 John Wiley & Sons, Ltd...

..Future research should aid such assessments by clarifying the mechanisms by which risk factors correlate with violence and by establishing the clinical usefulness of actuarial scales...

..I argue that a gold standard may not exist. A conclusion as to whether a defendant is fit to proceed requires a trade-off between a range of desired ends. This trade-off is inevitably influenced by the values of the examiner...

..The application of psychiatry to possibility explanations has not been widely explored. It offers the potential for the improved use of psychiatric evidence in criminal proceedings...

..Quantifying the contributions that different types of information make to the accurate prediction of offending offers the prospects of improved practice and better use of resources...

..quot; Courts have held that rendering transparent the reasons behind an expert's conclusions can minimize the damage done by ultimate issue testimony...

..The future standing of the specialty will depend not only on the practical utility of its responses to those opportunities and challenges, but also the ethical integrity of those responses...

..An alternative explanation, that we require greater room for error when the consequences are serious, implies a change to clinical practice and in the evidence doctors offer in court...

..This seems to resemble Dr. Felthous' preferred option, that mentally responsible choices are choices made in the presence of a relatively natural ability to have decided otherwise...

..Of the 63 with capacity, 6 (9.5%) were detained. CONCLUSIONS: Lack of treatment-related decisional capacity is a common but by no means inevitable correlate of admission to a psychiatric in-patient unit...

..84). CONCLUSIONS: In combination with a clinical interview, the MacCAT-T can be used to produce highly reliable judgements of capacity...

..Individual differences of assessors may be very important. Our findings suggest that senior psychiatrists score risks as lower. Possible explanations are discussed...

..The combinations of information were: a) age and sex, b) age, sex and history of criminality/violence c) age, sex, history of violence and drug use and d) age, sex, history of violence, drug use and personality disorder...

..Assessment tools have been devised in order to offer guidelines. We aimed to assess the inter-rater reliability of judgements made by a panel of experts judging the same interview transcripts where mental capacity had been assessed...

..International and intra-national variations in the care of this hypothetical woman are briefly discussed, and it is clear that in both countries medical care is compromised by attitudinal and political considerations...

..INTERPRETATION: Mental incapacity is common in acutely ill medical inpatients, and clinicians tend not to recognise it. Screening methods for cognitive impairment could be useful in detecting those with doubtful capacity to consent...

..A less acknowledged fact is that the proportion of societal violence attributable to schizophrenia is small...