La grave incongruencia existente entre el nuevo sistema de apoyo y la emisión del consentimiento informado por las personas con discapacidad / The Serious Inconsistency Between the New Support System and the Is-suance of Informed Consent by People with Disabilities

Recientemente, el Tribunal Constitucional ha dictado una sentencia por la que se confirmaba la constitucionalidad de dos resoluciones judiciales que habían ordenado la vacunación de una persona con discapacidad en contra de la voluntad de su tutor. El objeto de este artículo es analizar qué hubiera ocurrido de haberse producido esos hechos en la actualidad, tras la entrada en vigor de la Ley 8/2021 que regula un nuevo sistema de apoyo a la capacidad jurídica en favor de las personas con discapacidad. Tras analizar las nuevas medidas de apoyo que se han incorporado al Código Civil, se concluye informando de la existencia de un grave desajuste entre el Código Civil y la Ley 41/2002. (AU)

Recently, the Constitutional Court issued a ruling confirming the constitutiona-lity of two court resolutions that had ordered the vaccination of a person with disabilities against the will of their legal guardian. The purpose of this article is to analyze what would have happened if these events had occurred today, after the entry into force of Law 8/2021, which regulates a new system of support for legal capacity in favor of people with disabilities. After analyzing the new support measures that have been incorporated into the Civil Code, it is concluded that there is a serious mismatch between the Civil Code and Law 41/2002. (AU)

¿Cómo afectan la Ley 8/2021 y la ley 6/2022 a la investigación biomédica desarrollada en España? / ¿Com afecten la Llei 8/2021 i la Llei6/2022 a la investigació biomèdica desenvolupada a Espanya? / How do Act 8/2021 and Act 6/2022 affect biomedical research carried out in Spain?

La implementación de la Convención de Derechos de las Personas con Discapacidad obliga a los Estados Partes a realizar reformas legales que afectan a las normas que regulan la participación de las personas con discapacidad en la investigación biomédica clínica, en especial en los ensayos clínicos con medicamentos. En España, se ha tenido que reformar el Código Civil y la Ley General de Derechos de las Personas con Discapacidad para adecuar el ejercicio de la capacidad jurídica y para garantizar la accesibilidad cognitiva. Estas reformas podrían servir como modelo de las reformas que deben implementarse en otros países.(AU)

La implementació de la Convenció dels Drets de les Persones amb Discapacitat obliga als Estats Parts a realitzar reformes legals que afecten les normes que regulen la participació de les persones amb discapacitat en la investigació biomèdica clínica, especialment en els assaigs clínics amb medicaments. A Espanya, s'ha hagut de reformar el Codi Civil i la Llei General de Drets de les Persones amb Discapacitat per adequar l'exercici de la capacitat jurídica i garantir l'accessibilitat cognitiva. Aquestes reformes podrien servir com a model per a les reformes que han d'implementar-se en altres països.(AU)

The implementation of the Convention on the Rights of Persons with Disabilities obliges the States Parties to carry out legal reforms that affect the norms that regulate the participation of persons with disabilities in clinical biomedical research, especially in clinical trials with drugs. In Spain, the Civil Code and the General Act on the Rights of Persons with Disabilities have had to be reformed to adapt the exercise of legal capacity and to guarantee cognitive accessibility. These reforms could serve as a model for reforms to be implemented in other countries.(AU)

Capacidad jurídica y excepcionalidad jurídica en la Ley 3/2021, de regulación de la eutanasia. Una lectura en primera persona / Legal capacity and legal exceptionality in Law 3/2021, regulating euthanasia. A reading from a user perspective

Este artículo presenta una lectura situada a la Ley 3/2021, de 24 de marzo, de regulación de la eutanasia, desde la perspectiva de una persona usuaria de servicios de salud mental. El análisis se hace desde el marco jurídico de la Convención sobre los Derechos de las Personas con Discapacidad (CDPD), de Naciones Unidas, atendiendo especialmente a su artículo 12, de Igual reconocimiento como persona ante la ley. La lectura atiende a la adecuación (o no) del texto de la ley a la CDPD. En la discusión, se repasan los argumentos que se esgrimen desde la institución psiquiátrica no solo para oponerse al ejercicio de este nuevo derecho por parte de las personas psiquiatrizadas, sino también, por extensión, para perpetuar en el Estado español una situación de excepcionalidad jurídica en base a un criterio de trastorno mental. (AU)

This article presents a situated reading of Law 3/2021, of March 24, on the regulation of euthanasia, from the perspective of a mental health services' user. The analysis is made from the legal framework of the Convention on the Rights of Persons with Disabilities (CRPD), of the United Nations, paying special attention to its article 12, Equal recognition before the Law. The reading is focused on the adequacy (or not) of the text of the Law to the CRPD. In the discussion, the arguments put forward by the psychiatric institution are reviewed not only to oppose the exercise of this new right by psychiatrized people, but also, by extension, to perpetuate in the Spanish State a situation of Legal Exceptionality based on a criterion of mental disorder. (AU)

Legal capacity, developmental capacity, and impaired mental capacity in children under 16: Neurodevelopment and the law in Northern Ireland.

When people of any age, despite all possible support being provided, are unable to make a necessary decision, then it is important to have a legal framework which promotes and protects their rights. There is ongoing debate about how this can be achieved, in a non-discriminatory way, for adults but it is also an important consideration for children and young people. In Northern Ireland, the Mental Capacity Act (Northern Ireland) 2016, when fully implemented will provide a non-discriminatory framework for those aged 16 and over. Arguably this addresses discrimination based on disability but continues to discriminate based on age. This article explores some of the possible ways the rights of those aged under 16 could be further promoted and protected. These approaches may include: retaining the current combination of statute law but developing new guidance to inform practice for those aged under 16; codifying Gillick to clarify under what circumstances those aged under 16 can accept, and possibly also refuse, interventions; amend the Children (Northern Ireland) Order 1995 to provide a more comprehensive framework for health and welfare decision making; amend and extend the Mental Capacity Act (Northern Ireland) 2016 to apply to those aged under 16; or develop a new law specifically focused on the emerging capacity of those aged under 16. There are complex issues involved including how to consider emerging or developmental decision-making ability, and the role of those with parental responsibility, but the complexities involved should not prevent these issues being addressed.

Developing and piloting the Consumer Experience of Capacity Assessment Tool (CECAT).

Autonomy in personal decision-making (DM) is a fundamental human right. Yet, DM can be impaired for many reasons, including poor health. If impairments are suspected, they may be formally investigated via a capacity assessment. The 'consumer' experience of such assessments is largely unexplored. The Consumer Experience of Capacity Assessment Tool (CECAT) was developed to address this gap. Fifteen individuals pilot tested the CECAT. The CECAT was found to be quick to complete, and easily understood. The results showed a wide range of perceptions about capacity assessment and suggestions for improvement (e.g., better communication to consumers about what to expect). With further development, the CECAT could be adopted as a standardised method for understanding the consumer experience of capacity assessment. This perspective could then be integrated into future capacity assessment guidelines so that appropriate human rights-based approaches are incorporated into capacity assessments.

The rights to legal capacity, personal freedom, and safety during psychiatric hospitalizations at a general hospital.

The aim of this study is to analyze the exercise of rights to legal capacity, personal freedom, and safety during psychiatric hospitalizations at a general hospital in an inner city from the state of São Paulo, Brazil, from the perspective of patients. This is a cross-sectional qualitative research study. Data were collected by interviewing 20 patients in the process of being discharged from the studied hospital who agreed to participate in the investigation. The guiding instrument of this interview was based on the WHO QualityRights interview tool and the obtained data were processed by means of thematic and content analyses. Results showed that the legal processes resulting from the Psychiatric Reform did not ensure the full exercise of the human rights of people with mental disorders admitted at general hospitals. Participants generally did not know about their rights to have access to their information and referred that they received information about their own health or these were given to their representatives.

Cognitive Processes and Legal Capacity in Patients With Bipolar Disorder: A Brief Research Report.

The current study verified the association between cognitive process such as attention, executive functioning, and legal capacity in patients with bipolar disorder (BD). The sample consisted of 72 participants, assorted to episodic patients (n = 21), euthymic patients (n = 22), and healthy controls (HCs) (n = 29). We used the following neuropsychological measures: subtests of the Wechsler Abbreviated Intelligence Scale (WASI): vocabulary and matrix reasoning; Continuous Performance Test (CPT); Five Digit Test (FDT); and Rey-Osterrieth Complex Figure (ROCF). Euthymic patients expressed slower processing speed (FDT) compared to HC. They tended to make more errors with slightly worse discrimination, suggesting more impulsiveness (CPT, p < 0.01). On the contrary, episodic patients showed worse discrimination, committed more omissions, were more inconsistent with regard to response speed (CPT-3, p < 0.01), showed more difficulties in organizing their actions (ROCF: copy, p = 0.03), and were more rigid (FDT: flexibility, p = 0.03). The results suggest that bipolar patients in episode express more cognitive impairments that can compromise the quality of legal capacity. These results highlight the need for more protective support for episodic BD patients regarding legal capacity.

The UN Challenge to Guardianship and Surrogate Decision-Making.

In 2006, the United Nations issued the Convention on the Rights of Persons with Disabilities. The Convention, together with an accompanying commentary, urges governments to abandon laws authorizing guardianship and substitute decision-making for people with intellectual disabilities and to replace them with supportive decision-making laws that give all individuals the freedom to make choices reflecting their "will and preferences." Although critics point to ethical and legal problems with this approach, the Convention and commentary offer guidance to clinicians, ethicists, and others involved in evaluating medical decision-making. Whether or not it leads to formal legal action, the Convention rightly urges us to give people with cognitive impairments a greater role in decisions about their lives.

¿Cómo vivieron las personas con discapacidad la crisis de la covid-19? El caso de las personas apoyadas por entidades tutelares en España / How Did People with Disabilities Experience the COVID-19 Crisis? Situation of People Supportedby Guardianship Organizations in Spain

Las personas con discapacidad intelectual y del desarrollo (DID) apoyadas por entidades tutelares constituyen un grupo singular dentro de la población con DID. De ahí que la Asociación Española de Fundaciones Tutelares (AEFT) se haya propuesto conocer su experiencia durante la pandemia de la COVID-19, especialmente durante el confinamiento. Se ha llevado a cabo un estudio observacional, transversal, descriptivo y analítico mediante la aplicación de un cuestionario ad hoc en el que han participado 380 personas apoyadas por entidades asociadas a la AEFT. Los resultados indican que el 9 %tuvo un diagnóstico positivo por prueba PCR, el 24 % estuvo completamente aislado, un 16 % experimentó alteraciones de conducta y un 12 % de salud mental. Asimismo, se constató la clara desventaja de quienes viven en centros residenciales con puntuaciones globales dos puntos por debajo de quienes viven de manera independiente. Analizado por factores, en una comparación de personas que viven en residencias frente a aquellos que viven independientemente, se encontraron diferencias significativas. Estas tuvieron un impacto negativo en lo relativo a la información, la comunicación y contacto y, sobre todo, en la vida en comunidad para aquellas personas viviendo en centros residenciales. El estudio muestra, sin embargo, un efecto positivo en salud a favor de las residencias. Con todo, se concluye que es necesario seguir promoviendo la autonomía de las personas y la transición hacia un modelo habitacional más inclusivo que procure el pleno disfrute del artículo 19 de la Convención. (AU)

People with intellectual and developmental disabilities (IDD) support-ed by guardianship organizations are a unique group within the IDD population. For this reason, the Spanish Association of Guardianship Foundations (AEFT) aim to find out about their experience during the COVID-19 pandemic, especially during lock-down. An observational, cross-sectional, descriptive and analytical study was carried out through the application of an ad hoc questionnaire in which 380 people supported by entities associated with the AEFT participated. The results indicate that 9 % had a positive diagnosis by PCR test, 24 % were completely isolated, 16 % experienced be-havioral alterations and 12 % mental health problems. There was also a clear disadvan-tage for those living in residential care homes scoring overall two points lower compared to those living independently. Significant differences were found when breaking down by factors after a statistical comparison of subjects living in residential care home vs independent homes. These differences had a negative impact in information, commu-nication and contact and, above all, community living for people living in residentialcare homes. On the contrary the effect on health was positive in favour of the residential carehomes. Overall, it is concluded the need to continue promoting people’s autonomy and the transition towards a more inclusive housing model that seeks the full enjoyment of article 19 of the Convention. (AU)

Between the convention and conventional practice: Israeli social workers' recommendations regarding the legal capacity of people with disabilities.

BACKGROUND: Following the convention on the rights of persons with disabilities (CRPD), various countries have recently amended their legal capacity laws with the aim of restricting the use of guardianship and increasing the use of other, less restrictive practices, mainly supported decision making. As social workers have a key role in carrying out these reforms, this study examines how Israeli social workers make legal capacity-related decisions. METHOD: Semi-structured interviews with 27 Israeli social workers. RESULTS: Thematic analysis identified three factors driving social workers' recommendations regarding guardianship and supported decision-making: the person's diagnosis and functioning level, and the presence of a supportive family. A fourth factor, the person's preferences, played a complex and more limited role. CONCLUSIONS: Many changes have yet to be made to fully apply the support paradigm in Israel, since social workers still tend to base their recommendations on factors not fully aligned with the CRPD.

Capacity Trajectory in the Context of Dementia: A Case of Exercising Rights in Troubled Civil Life.

For years, Common law and Civil Code have determined the legal age as majority which defines adulthood, giving a presumption of legal capacity to adults. At this age, all adults are presumed to be capable of making their own decisions, protecting their interests and exercising the rights they enjoy in the acts of their civil life. This legal presumption of capacity structures the life-course of adults and allows them to act and make decisions either in daily life or for exceptional civil acts, for instance, marriage. Domestic laws, including French laws, do provide for certain exceptions, especially for persons suffering from disease or disabilities. The use of substitutive decision-making, or "coercive legal" measures, is increasing. At the same time, these legal substitutive decision-making measures have encountered challenges. The cornerstone Article of International Convention on the Rights of Persons with Disabilities (CRPD) reaffirms the exigence of equal recognition of all persons before the law with equal capacity. The interpretation of this article 12 is subject to considerable controversy. The controversy around CRPD and the paradox between the normative evolution of fundamental rights and the increasing uses of legal substitutive decision-making measures in social practices raise questions about the place of this legal presumption of capacity. In this article, we wish to tackle this controversy by starting with situations where the daily capacity to exercise one's rights becomes an issue for the professional or family circle. What happens when persons seem unable to understand the consequences of their actions or when they behave incomprehensibly according to their close ones? When should others around the person worry about the person's ability to take care of oneself? What happens when a person's ways of functioning change? Is it an indication that his or her state of health is experiencing changes? That the person's needs have evolved? What does this imply for family and friends, especially in terms of actions or substitute decisions? Using the core notion of "capacity trajectory," this article intends to empirically shed light on how rights and legal capacity are exercised in situations of vulnerability. We wish to demonstrate that the presumption of capacity requires certain "conditions of capacity" in practice.

Forensic Value of Genetic Variants Associated with Anti-Social Behavior.

Insanity defense is sometimes invoked in criminal cases, and its demonstration is usually based on a multifactorial contribution of behavioural, clinical, and neurological elements. Neuroradiological evidence of structural alterations in cerebral areas that involve decision-making and moral reasoning is often accepted as a useful tool in these evaluations. On the other hand, the genetic predisposition to anti-social behavior is still controversial. In this paper, we describe two cases of violent crimes committed by young carriers of genetic variants associated with personality disorder; both the defendants claimed to be insane at the time of the crime. We discuss these cases and review the scientific literature regarding the relationship between legal incapacity/predisposition to criminal behavior and genetic mutations. In conclusion, despite some genetic variants being able to influence several cognitive processes (like moral judgement and impulse control), there is currently no evidence that carriers of these mutations are, per se, incapable of intentionally committing crimes.

Medicalisation and participation in legal capacity determinations in Chile.

This paper provides an examination of the process used by ordinary courts in Chile when making legal capacity determinations. It provides an up-to-date account of various aspects of law and procedure related to legal capacity in this jurisdiction. Also, by drawing on semi-structured interviews with judges, this paper examines judicial understandings of legal capacity decision-making focusing on problems related to the medicalisation of mental disability and the participation of persons with disabilities in legal capacity procedures.

Supported Decision Making in South America: Analysis of Three Countries' Experiences.

Background. Following the adoption of the UN Convention on the Rights of Persons with Disabilities, there has been increased interest in supported decision making (SDM) as a strategy to realize the right to legal capacity of persons with intellectual and psychosocial disabilities. Support for decision making has been delivered formally through SDM services as well as informally through interpersonal networks. Various SDM programs have made efforts to systematize informal support, showcasing a variety of SDM delivery models that could benefit SDM implementation in low- and middle-income countries. Methods. This article examines and discusses three SDM projects in South America (Colombia, Peru, and Argentina) that have been directly implemented by civil society organizations, including organizations of persons with disabilities and their families. Analyzed program components include person-centered planning, the nature of support relationships, the presence of supporter training, community involvement, and the utilization of quality assurance measures such as monitoring and program evaluation. Conclusions. The results and learning from these initiatives constitute a valuable source of information for legislators and policymakers for the future development of supported decision-making programs, which are an essential form of support and a mechanism for fulfilling the right to legal capacity in low resource settings.

A capacidade jurídica das pessoas com deficiência: uma ressignificação necessária à luz dos direitos humanos e do modelo social de deficiência / The legal capacity of persons with disabilities: a necessary reframing in the light of human rights and the social model of disability / La capacidad jurídica de las personas con discapacidad: resignificación necesaria a la luz de los derechos humanos y del modelo social de discapacidad

Objetivos: analisar o novo paradigma da capacidade jurídica das pessoas com deficiência, instaurado pelo artigo 12 da Convenção Internacional sobre os Direitos das Pessoas com Deficiência e reiterado pela Lei Brasileira de Inclusão da Pessoa com Deficiência ­ Lei nº 13.146/2015 ­, bem como identificar possíveis obstáculos ao reconhecimento da capacidade, em igualdade de condições com as demais pessoas. Metodologia: a pesquisa é qualitativa, documental e bibliográfica, tendo sido baseada em normas constitucionais e legais, em documentos oficiais da Organização das Nações Unidas e em livros e artigos científicos sobre o tema. Resultados: o mapeamento dos óbices que têm desencadeado oposição em relação ao tema permitiu a definição de estratégias para seu enfrentamento, que somente se afigurarão viáveis por meio do empreendimento de esforços amplos para a materialização do direito das pessoas com deficiência ao exercício da sua capacidade, sem discriminação. Conclusão: a superação da resistência às inovações trazidas pela Convenção Internacional sobre os Direitos das Pessoas com Deficiência e repetidas na Lei nº 13.146/2015 pressupõe uma ressignificação do direito à capacidade, à luz dos direitos humanos e do modelo social de deficiência. Pressupõe, ainda, o engajamento de toda a sociedade em um processo crítico, combativo e emancipador, destinado ao rompimento das amarras desencadeadas pelas opressões e usurpações que sempre aprisionaram e alienaram ­ da sociedade e da História ­ essas pessoas.

Objectives: to analyze the new paradigm of the legal capacity, established by the article 12 of the Convention on the Rights of Persons with Disabilities and reaffirmed by the Brazilian Law of Inclusion of Persons with Disabilities ­ Law nº 13.146/2015 ­, as well as to identify possible obstacles of recognizing the capacity on equal terms with others. Methods: this study is qualitative, documental and bibliographic and is based on constitutional and legal norms, official documentation of the United Nations and books and articles on the subject. Results: the mapping of the obstacles that have triggered opposition in relation to the theme allowed the definition of strategies for their confrontation, which will only appear viable through the undertaking of ample efforts for the materialization of the right of persons with disabilities to exercise their capacity with no discrimination. Conclusion: the overcoming of the resistance to the innovations brought by the Convention on the Rights of Persons with Disabilities and repeated on the Law nº 13.146/2015 presupposes reframing of the right considering human rights and the social model of disability. It also presupposes the engagement of the whole society in a critical process, combative and emancipatory, destined to breaking the chains brought about by oppression and usurpation that have always imprisoned and alienated ­ of society and of history ­ these persons.

Objetivos: análisis del nuevo paradigma de la capacidad jurídica, establecido por el artículo 12 de la Convención Internacional sobre los Derechos de las Personas con Discapacidad y reiterado por la Ley Brasileña de Inclusión de la Persona con Discapacidad ­ Ley nº 13.146/2015 ­, bien como identificar posibles obstáculos al reconocimiento de la capacidad, en igualdad de condiciones con las demás personas. Metodología: la investigación es cualitativa, documental y bibliográfica, habiendo sido basada en normas constitucionales y legales, en documentos oficiales de la Organización de las Naciones Unidas y en libros y artículos científicos acerca del tema. Resultados: el mapeo de los obstáculos que vienen desencadenando oposición en relación al tema permitió que se definieran estrategias para su enfrentamiento, que solo resultarán viables por medio de la realización de esfuerzos amplios para la materialización del derecho de las personas con discapacidad al ejercicio de su capacidad, sin discriminación. Conclusión: la superación de la resistencia a las innovaciones que trajo la Convención Internacional sobre los Derechos de las Personas con Discapacidad y que se repiten en la Ley nº13.146/2015 presupone una resignificación del derecho a la luz de los derechos humanos y del modelo social de deficiencia. También presupone el envolvimiento de toda la sociedad en un proceso crítico, combativo y emancipador, destinado a romper las cadenas de las opresiones y usurpaciones que siempre encarcelaron y promovieron enajenación de esas personas, tanto de la sociedad cuanto de la Historia.

Understanding of legal aspects of Alzheimer disease among caregivers, medical students, and healthcare professionals. / Nivel de conocimiento de aspectos legales de la enfermedad de Alzheimer en cuidadores, estudiantes y profesionales sanitarios.

INTRODUCTION: Modification of legal capacity is a protective measure involving a judicial procedure; a deeper understanding of this concept is necessary for its execution in such vulnerable populations as patients with Alzheimer disease (AD). Unawareness of a patient's legal capacity and failure to adequately protect them may give rise to situations of avoidable risk. PATIENTS AND METHODS: We designed a closed survey for informal caregivers of patients with AD, the general population, medical students, and healthcare professionals to determine the degree of understanding of the concept of modified legal capacity. RESULTS: The survey was administered to a total of 401 individuals: 100 caregivers, 117 members of the general population, 128 medical students, and 58 healthcare professionals. Women accounted for 66.1% of the sample (n=265); mean age (SD) was 43.2 (0.9) years. The overall mean survey score was 7.7 (0.9). By group, caregivers scored 7.5 (0.18), the general population scored 6.9 (0.16), students scored 8.4 (0.17), and healthcare professionals scored 8.7 (0.20) (P=.000). Of all respondents, 78.8% had not received information on legal issues related to dementia. Among students, no significant differences in survey score were observed between members of different years (P>.05). CONCLUSIONS: There is a low level of understanding of modified legal capacity and of the legislation governing issues related to cognitive impairment among caregivers, the general population, and even medical students. It is important to design strategies to improve understanding of the concept, particularly among future healthcare professionals.

Gradient Legal Personhood for AI Systems-Painting Continental Legal Shapes Made to Fit Analytical Molds.

What I propose in the present article are some theoretical adjustments for a more coherent answer to the legal "status question" of artificial intelligence (AI) systems. I arrive at those by using the new "bundle theory" of legal personhood, together with its accompanying conceptual and methodological apparatus as a lens through which to look at a recent such answer inspired from German civil law and named Teilrechtsfähigkeit or partial legal capacity. I argue that partial legal capacity is a possible solution to the status question only if we understand legal personhood according to this new theory. Conversely, I argue that if indeed Teilrechtsfähigkeit lends itself to being applied to AI systems, then such flexibility further confirms the bundle theory paradigm shift. I then go on to further analyze and exploit the particularities of Teilrechtsfähigkeit to inform a reflection on the appropriate conceptual shape of legal personhood and suggest a slightly different answer from the bundle theory framework in what I term a "gradient theory" of legal personhood.

Análise da capacidade jurídica dos pacientes idosos no Brasil a partir do referencial dos Direitos Humanos / Analysis of the legal capacity of elderly patients in Brazil from the Human Rights perspective / Análisis de la capacidad legal de los pacientes mayores en Brasil desde el marco de los Derechos Humanos

Objetivo: o artigo visa discutir a capacidade jurídica dos pacientes idosos a partir do referencial dos Direitos Humanos, de modo a fomentar o debate acerca da inadequação da legislação brasileira para aferir a capacidade decisional e a consequente mitigação da autonomia. Metodologia: estudo teórico-documental baseado na pesquisa de Albuquerque sobre capacidade jurídica e Direitos Humanos e, internacionalmente, na Convenção sobre os Direitos das Pessoas com Deficiência e na Convenção Interamericana sobre a Proteção dos Direitos Humanos dos Idosos. No campo nacional, abordou-se a regulamentação dos Códigos Civil e de Processo Civil sobre interdição e curatela. Resultados: constatou-se que o método de aferição da capacidade jurídica no Brasil está dissociado do novo paradigma internacional, pois a avaliação ocorre por meio de perícia médica que busca aferir deficiências mentais, e não a habilidade para a tomada de decisões específicas. Conclusão: o paciente idoso pode ser protagonista ativo de sua terapêutica, desde que tenha a sua autonomia promovida mediante a utilização dos suportes adequados de tomada de decisão, que carecem de ser incorporados no país.

Objective: the article discusses the legal capacity of elderly patients from the human rights perspective and debate about the inadequacy of Brazilian legislation to assess the decision-making capacity and therefore leading to the mitigation of autonomy. Methods: the theoretical and documentary study conducted was based on Albuquerque's research on legal capacity and human rights; on the principles of the Convention on the Rights of Persons with Disabilities and the Inter-American Convention on the Protection of the Human Rights of Older Persons; and the Brazilian regulation of the Civil and Civil Procedure Codes on guardianship. Results: the method for assessing the legal capacity in Brazil is dissociated from the international paradigm, because the assessment is based on the measurement of mental deficiencies or disorders, and not the ability to make specific decisions. Conclusion: elderly patients can be active protagonists of their therapy if their autonomy is promoted through the appropriate decision-making support to still be applied in Brazil.

Objetivo: el artículo tiene como objetivo discutir la capacidad legal del paciente anciano desde el marco de los derechos humanos, con el fin de fomentar el debate sobre la insuficiencia de la legislación brasileña, los mecanismos equivocados para evaluar la capacidad de toma de decisiones y la consiguiente mitigación de la autonomía. Metodología: el estudio teórico y documental aquí realizado se basó en la investigación de Albuquerque sobre capacidad jurídica y derechos humanos y, internacionalmente, en la Convención sobre los Derechos de las Personas con Discapacidad y la Convención Interamericana para la Protección de los Derechos Humanos de las Personas Mayores. En el ámbito nacional, se abordó la regulación de los Códigos de Procedimiento Civil y Civil sobre interdicción y tutela. Resultados: se descubrió que el método para medir la capacidad legal en Brasil está disociado del nuevo paradigma internacional, porque la evaluación se lleva a cabo a través de la experiencia médica que busca medir discapacidades o trastornos mentales, y no la capacidad de tomar decisiones específicas. Conclusión: los pacientes de edad avanzada pueden ser protagonistas activos de su terapia, siempre que se promueva su autonomía, mediante el uso de los apoyos adecuados para la toma de decisiones, que que deben incorporarse en el país.

Dementia, Treatment Decisions, and the UN Convention on the Rights of Persons With Disabilities. A New Framework for Old Problems.

The UN Convention on the Rights of Persons with Disabilities has been at the center of considerable debate in the field of mental health. The discussion has caught up in particular after the publication of General Comment No. 1 in which the Committee on the Rights of Persons with Disabilities proposes a particularly radical interpretation of Article 12 of the Convention. Such a document has triggered skeptic and at times hostile reactions especially by psychiatrists, together with some positive comments. In this context, there is sometimes the tendency to focus only on the problematic aspects of the rights and support based model proposed by the CRPD and its Committee, forgetting that also "pre-CRPD" legislations on legal capacity present significant shortcomings. In this contribution I focus on the paradigmatic case of treatment decisions of people living with dementia with the aim to show how a number of provisions emerging from the CRPD and General Comment No. 1 can contribute to overcome the issues characterizing the traditional model of legal capacity and consent to treatment. First, I provide a brief overview of the provisions contained in the CRPD and General Comment No.1, summarizing the debate in this area. Then, I move to the case of treatment decisions of people living with dementia, analysing the main issues posed by the traditional model of capacity still characterizing European legislations. I will show how such problems and the solutions previously advanced by academics and practitioners resound in many ways with those identified by the CRPD and its Committee. In the second part, I analyse one by one the main provisions proposed by the CRPD and the Committee, studying how they can be applied in the area of treatment decisions of people living with dementia. In this context I point out the possible interpretations of the various provisions and their pros and cons, also referring to ongoing initiatives providing an insight on how such norms might work in practice.