Book review: The Geriatrician in Court

Dr Shane O’Hanlon is a consultant geriatrician and Honorary Secretary of the BGS. He holds a law degree and has a special interest in medicolegal matters. He tweets @drohanlon

Most doctors spend their career hoping never to see the inside of a courtroom! While geriatricians are probably among the most rarely sued specialists, we can still have quite frequent involvement with the law – the Coroner’s Court is a good example. There is also an increasing amount of medicolegal work related to dementia, deprivation of liberty safeguards and mental capacity. In this environment there has been a gap in the market for a book that focuses specifically on our needs, but retired geriatrician Dr Geoffrey Phillips is at hand with help.

The Geriatrician in Court” is a handbook of “how to do it” based upon his thirty years of experience in preparing medico-legal reports and attending court to give expert evidence. The book covers all the main topics over the course of 226 pages. It begins with an outline of the legal system, criminal versus civil law, negligence and burden of proof. Important areas such as mental capacity, testamentary capacity, abuse, medical error and resuscitation all feature. Continue reading

July 2017 issue of Age and Ageing journal is out now

The July 2017 issue of Age and Ageing, the journal of the British Geriatrics Society is out now.  A full table of contents is available here, with editorials, research papers, reviews, short reports, case reports book reviews and more.AA_46-03

Hot topics in this issue include:

  • Care home leadership
  • Physical restraint
  • Diet and muscle function
  • Prescribing for frail older
    adults
  • Treatment of overactive
    bladder

    The Editor’s View article gives an overview of the issue with a summary of highlights. This article is free to read and can be viewed here. Continue reading

    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