cognitive impairment

Invoking and banishing the dread demon “Lead”

Some researchers have fingered a surprising culprit for the crime wave that ended in the 1990s: lead, mainly from leaded fuel. We know that lead leads to development difficulties in children, and in country after country, lead emissions closely mirror the crime rate 23 years later – after those children have grown up into mature, irresponsible adults.

A nice story – only problem is, people aren’t very interested in it. We prefer to tell stories about actual human villains, morality tales with clear blame and praise and entertaining situations (contrast the amounts spent fighting terrorism versus road accidents). Lead causing crime just isn’t sexy.

So to combat this universal human tendency, that causes us to misdirect our efforts and our focus, I propose we should treat Lead as an human-like villain. In its oily lair, the demon Lead rubes its metallic hands together in glee, imagining the millions of children whose developments it is stunting, and the thousands of young men it tipped into criminality, and the wailing of their victims. It plots further increases of its empire of crime, and gnashes grey teeth in frustration as heroic regulator squeeze its powerbase out of the air, the fuel, and the water.

You should already feel your emotional priorities shifting. This alternative visions should enable us to give Lead the attention it deserves, in comparison with other lesser threats with more appealing stories. Use our story-biases in the service of good – we can feel the appropriate amount of joy when we triumph over Lead; emotions, not just reason, are needed to keep up our motivations in dealing wit these threats.

And then the demon can be joined in its dark imaginary lair by the vicious Vampire Malaria, the Zombie-Lord of the Road Traffic Accident, and the bloody Psychopathic Death Cult of Cardio-Vascular Diseases. To arms, good citizens of the world, against these sinister anthropomorphised and correctly prioritised threats!

Abortion and the cognitively impaired mother

It will be interesting to watch the reception of a recent Court of Protection case, as yet unreported, in which a woman with profound learning difficulties was found to have capacity to decide not to terminate her pregnancy.

As so often, the case decided nothing new. But it is a timely reminder of the trite but often overlooked principle that capacity is not an all or nothing thing. The question: ‘Does she have capacity?’ is always dangerously incomplete. The correct question is always ‘Does she have capacity to decide X?’

There was no doubt that she did not have capacity to manage many aspects of her affairs. She was in the bottom 1% of the population so far as intellectual function was concerned. Deputies were appropriately appointed. But, so far as the continuation of her pregnancy was concerned, so what?

It was decided as a matter of fact that she had capacity to decide whether or not to continue with, or to terminate, the pregnancy. And that meant that the Court of Protection had no jurisdiction to decide the matter. No best interests determination could lawfully be made. Continue reading