Mental Capacity and Deprivation of Liberty – an update on reform

Caroline Cooke is Policy Manager at BGS and Premila Fade is BGS’s End of Life Care Lead.  Here they explain the background to, and significance of, the report published by the Law Commission, “Mental Capacity and Deprivation of Liberty” on 17 March 2017.

What are DoLS?  The Deprivation of Liberty Safeguards (DoLS) are a set of protections for adults who lack the mental capacity to consent to deprivation of their liberty by, for example, admission either to hospital or a care home for treatment or care.  They were introduced as part of the Mental Health Act 2007.  The intention behind their introduction was to ensure that no-one is deprived of liberty without good reason, and the right of legal challenge is built into the authorisation process.  The idea was to close the so called ‘Bournewood gap’ whereby adults admitted informally (i.e. not via the Mental Health Act) did not have an automatic right to appeal.  The European Court of Human Rights (HL v United Kingdom) ruled that this lack of safeguards was a breach of article 5 ‘The right to Liberty’ of the Human Rights Act. Continue reading

Spring Speakers Series: Coroner’s Inquest

Mr Leslie Hamilton recently took early retirement (pressure of the on-call transplant rota) as a cardiac surgeon but continues to sit as Assistant Coroner. He is currently on the Council of the Royal College of Surgeons and is a past President of SCTS (Society for C/Th Surgery). He will be Chairing a special workshop at the BGS Spring Meeting on Thursday 27 April.

You have just received a letter asking you to attend Court. You get a tachycardia. What is it about?

There are four courts which doctors can face in relation to their medical practice.  It could be the GMC’s Medical Practitioners Tribunal Service (the old Fitness to Practice panels) – though strictly speaking it is a Tribunal rather than a court. It is however adversarial in nature with full legal representation.  It could be in relation to a clinical negligence claim – in the civil court. An increasingly common occurrence in many specialties. Or very rarely it could be for the criminal court on a charge of wilful neglect or gross negligence manslaughter. Continue reading

Desperately Seeking Ethics: Reflections on attending a research ethics committee meeting

Liz Charalambous is a nurse and PhD student. She tweets at @lizcharalambou and is a regular guest blogger for the BGS.

me-fbI am in the second year of a PhD researching volunteers in dementia and acute hospitals. The project came about as part of my clinical work as a staff nurse in older person acute care. It was while working on a prevention of delirium research study, I realised that volunteers could play an important role.

The first year of my PhD has been spent mainly completing modules and designing the project from scratch. I have lost track of how many drafts of countless documents have been sent to my long suffering supervisors as they guide me towards refining my ideas, sifting through my thousands of words to put together a robust study which will stand up to scrutiny. Continue reading

Utilitarian versus Kantian ethics

Shuli Levy is a locum consultant geriatrician at the Hammersmith hospital, London, running liaison geriatrics and MDT support teams for tertiary specialist services. She has recently taken over as head of the BGS Ethics and Law special interest group. 

kant_461965I recently gave a talk to doctors and medical students in my department, about the difference in Utilitarian versus Kantian ethics and the implications for our practice as generalists and as geriatricians. It surprised me that no one, apart from one medical student, had heard the terms before. Not for the first time, I reflected on how so much of our daily work as geriatricians involves complex ethical and legal decisions but so little time is devoted to exploring and understanding them. We may use our precious CPD time to learn more about endocrinology in older people or novel approaches to the mitral valve, but rarely encounter patients for whom this is relevant in clinical practice. In contrast, ethical questions, and the statutory duties they engender, arise on every medicine for the elderly ward round, on most acute takes, daily in the community and in every MDM. Continue reading

Systematic biases in death certification: a job for the Medical Examiner?

Katherine Sleeman is an NIHR Clinician Scientist and Honorary Consultant in Palliative Medicine at the Cicely Saunders Institute, King’s College London. In this blog she discusses her recent Age and Ageing paper on death certification in dementia. @kesleeman

portraitIt is frequently said that there are just two universal certainties: death and taxes. While HMRC is responsible for ensuring that taxes are paid, information about who dies, where, and how, is gathered through death certification.

Dementia is a public health priority of increasing importance. In 2014, it was reported that dementia had overtaken cancer and cardiovascular disease as the most common cause of death for women in England. We have previously shown that the proportion of death certificates in England where dementia was mentioned as a cause of death doubled between 2001 and 2010.

But what is unclear is why dementia deaths appear to be increasing. Is it due to an increasing prevalence of dementia in our ageing society? Due to increased detection of dementia, perhaps? Or does this increase simply represent an improvement in death certification practices over time? Continue reading

Deprivation of liberty safeguards

In March this year, the Supreme Court handed down its judgement on two cases which will have significant impact in determining whether arrangements made for the care and/or treatment of an individual lacking capacity to consent to those arrangements amount to a deprivation of liberty.shutterstock_46716664

Key points of the Supreme Court Judgement: The Court ruled that there is a deprivation of liberty in terms of Article 5 of the European Convention on Human Rights if the person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements. Whether the person objects to the arrangement or not is irrelevant, as is the ‘relative normality of the placement in the context of the person’s needs.’ Continue reading

Dyson’s Law and the Medical Registrar: A frontline view

This is a follow-up to Dr Aroras’ earlier blog about the recent legislations surrounding Do Not Resuscitate [DNR] orders. Dr Suthahar, who is a final year geriatric registrar, reflects on the immediate impact of the legislation on the wards and the acute general take.shutterstock_139322513

They say change comes slowly to the NHS… Think of the time it takes for the latest NICE guidance, CQUINs, newest drug or quality measures to filter down to the frontlines of clinical work. However in one stroke Lord Dyson in his landmark ruling on DNR orders and the legal necessity to communicate the DNR order to the patient or family members, has effectively changed clinical practice overnight. Continue reading

‘To resuscitate or not to resuscitate’ is not the question, or is it?

Amit Arora is a consultant physician in care of older people and Chair of the England Council of the BGS. shutterstock_127283141

A landmark ruling was recently handed down by the Court of Appeal in the case of Janet Tracey v Cambridge University Hospital NHS Foundation Trust and others. The Court ruled that Cambridge University Hospital Trust violated Mrs Tracey’s (Article 8 of the European Convention on Human Rights) Right to Respect for Private Life in failing to involve her in the process which led to making a DNAR decision. It also said that it was a duty of common law to consult. Continue reading

PANICOA – the Prevention of Abuse and Neglect in the Institutional Care of Older Adults

shutterstock_105457523Laura Izzard is an Specialty Trainee in Geriatric Medicine at Kings College Hospital, London

PANICOA – the Prevention of Abuse and Neglect in the Institutional Care of Older Adults – is a joint research initiative between Comic Relief and the Department of Health.

Published in December 2013, the PANICOA report ‘Respect and Protect’ draws together the findings of eleven individual research studies commissioned to examine the complex issue of mistreatment of older people in hospitals and care homes. It outlines three vantage points i.e. “narratives” reflecting the perspectives of residents and patients, care staff and care organisations. Themes emerging from the PANICOA Narratives were used by the authors to produce a number of recommendations intended to reinforce and/or improve current practice.

Continue reading

Ethics and care for older people approaching the end of life – Symptoms, Choices and Dilemmas

An RCPE Symposium with live links and international web streaming

Thursday, 3 April 2014.
Royal College of Physicians of Edinburgh.
The Queen Mother Conference Centre, Edinburgh.

The care of patients approaching the end of life is once again a controversial and high profile topic. The provision of high quality care to older patients with complex health and social care needs brings a unique set of clinical and ethical challenges. Lectures and interactive case discussions will cover symptom control in chronic pain, vertebral fracture and advanced heart failure; ways of delivering advance care planning for older people in the community; ethical decision making in advanced dementia, around nutrition at the end of life, and around escalation of care. Our endowed lecture will consider how we can deliver high-quality end of life care across the health service in the post-Liverpool Care Pathway era. A series of interactive cases will allow exploration of practical approaches to ethical dilemmas at the end of life.

This symposium will be of practical value to all healthcare professionals in the multidisciplinary team caring for frail, older patients including geriatricians, primary care physicians, general physicians and specialists in palliative medicine. Attendees will improve their knowledge of symptom control in difficult conditions, improve their decision-making in challenging ethical situations including advanced dementia, and will gain perspective on the recent debate regarding the optimal organisation and delivery of end of life care in the hospital and community.

Dr Miles Witham
Chair, Organising Sub-Committee

Click here for more information