Objective: To comment on clinical and ethical aspects of capacity assessments in a setting of dementia, within a specific context provided by the Adults with Incapacity (Scotland) Act 2000.
Design: A description of the key principles underpinning this first Act of the Scottish Parliament is given plus an account of how the chosen definition of incapacity impacts particularly on those suffering from dementia.
Materials and Methods: Particular attention will be paid to the importance of capacity assessments being specific to purpose and to issues arising from this for clinicians. Conceptualisation of the competences involved is still fairly broad and there remains a relative lack of strictly defined legal tests as case law is awaited. Feedback is taking place on available guidance and healthy debate is likewise ongoing.
Results: A necesarily subjective account is offered of my own experience, and that of psychiatric colleagues, in implementing medical aspects of the new legislation. An analogy is suggested between the assessment of "InCapacity" in dementia and the diagnostic process of psychiatry in general. An emphasis is placed on ethical dilemmas which have arisen or are envisaged.
Conclusion: A clinical perspective is provided of a topic about which the succeeding speakers will offer amplifications of legal, psychological and philosophical aspects. It is to be hoped that any unique aspects of the Scottish approach will be of help to others in their assessments of capacity against the background of dementia as an illness and across the many settings in which often complex decisions can be required.
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