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.

I 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.

‘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. 

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.

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

Preventing and stopping abuse

Mary Cox, Safeguarding Advisor for Age UK will be speaking at the British Geriatrics Society Autumn conference in November 2013.  Her work involves helping older people, their family, carers, and professionals to prevent and stop abuse.  Her presentation will include narratives that demonstrate the dilemmas of speaking out about abuse and the impact harm has on people’s lives.

Adults suffer abuse when their human or civil rights are breached. The absolute human right ‘not to be tortured or treated in an inhuman or degrading way’ should be promoted by us all and be reflected in the quality of the services we provide.   It is Important that we enable people to have control over their own lives, treat them with dignity, support them to have the best physical and mental health possible, and facilitate their financial security.

Dying isn’t Working

Following Kate Granger’s blog entry on her personal response to the withdrawal of the Liverpool Care Pathway, we present a blog from Jason Suckley, director of Policy and Campaigns at Sue Ryder, explains what healthcare professionals could do to improve end of life care

In a civilised society and 65 years since the establishment of the NHS, it’s totally unacceptable that individuals and their families remain unsupported at the one of the most life-changing and emotionally challenging times.  Your diagnosis, where you live, or who your doctor is shouldn’t pre-determine whether or not you have a good death – we want to change that.

To work towards addressing the problem, in June, we launched our campaign, “Dying isn’t Working”.  The campaign is based on our own experience as a service provider of end of life care and evidence from two reports we’ve produced with think-tank Demos – Ways and Means (published on 19 June), looking at barriers to accessing end of life care, and A time and a place (published on 9 July), exploring what people want at end of life.  Insights from the reports highlight a number of ways in which healthcare professionals can improve end of life care for all.

Interesting times indeed – the Francis Report and Care of Older People

Prof Paul Knight is President of the BGS and is Director of Medical Education and Consultant Physician at the Royal Infirmary, Glasgow.

The oft quoted expression, “may you live in interesting times”, not as approbation, but as a threat, certainly seemed to apply recently.

Apparently, it probably isn’t a Chinese proverb but appeared in a science fiction novel in the 50’s. As I was preparing my contribution to this edition of the newsletter the Francis report was released. There will be much about the report elsewhere in this and subsequent newsletters, as we consider what it means to the way we work.

Inevitably, Francis means most to colleagues working in the NHS in England, but I would urge all to review the Executive summary, not least because Robert Francis will be an invited speaker at the Belfast Spring Meeting and it will give you some context. The recommendations for regulators such as the GMC and NMC will apply UK wide and not just in England.

BGS Spring Scientific Meeting is in Belfast

On behalf of the President of the BGS and the 2013 Spring Meeting Organising Committee, Dr Rosemary Kelly, extends a warm welcome to the BGS Spring Meeting in Belfast which is taking place from 17 – 19 April 2013.

A combination of local, national and international experts will deliver an interesting and varied scientific programme. The Northern Ireland Minister for Health will be in attendance and Thursday’s guest lecture will be delivered by Robert Francis QC, author of the newly released Francis report.

We begin the conference on Wednesday afternoon, highlighting exciting developments within the expanding areas of nursing home medicine, psychiatry liaison and orthogeriatric medicine. There will also be a thought-provoking analysis of medicolegal aspects of geriatric medical practice as well as a timely update on appraisal and revalidation.

BGS on the Francis Report

The Francis report challenges the NHS at all levels. Many of the failings in care described in the report affected old and vulnerable patients. Policy, regulatory, organisational, funding and professional lessons must be learnt.

There must be an immediate focus on what we know will improve quality. Central to this is the need for health professionals to demonstrate clinical leadership. They should be advocating for patients and their carers, challenging poor practice and embodying good practice. No doctor or nurse should assume that failings in basic care, safety or dignity are someone else’s problem and all should speak out when they see neglect or poor care. This extends to clinicians in senior leadership roles in hospitals who should have a clear focus on the care delivered on wards and experienced by patients and their families.

Debate:- Funding social care for older people- The Gathering Storm

The question of how to best fund care of frailer older people in their latter years remains unresolved. Current rules require all older people with assets above £23,250 to personally fund all care requirements and all assets [including property] are included in financial assessments. The arrangements have been criticised by many for forcing those who have worked hard to build assets through their life to

In the past 13 years there had been two independent commissions, three public consultations and now three white papers. The latest of these, the Dilnot report, called for a system for the elderly whereby there was universal coverage: the total cost of care would be capped at £35,000 with social support for old people extended to those with assets of £100,000, incurring a total estimated cost of £4.2 billion in 2025.

The social care issue is thorny and has multiple facets:-

• Can we afford it? – the present economic climate brings to harsh reality the ability of the welfare state model to provide for all aspects of life on limited resources
• Who should fund it? – the government, families or the third sector
• Universal coverage? – Should any legislation cover all people without any exclusions or prejudice? What happens to those, with financial means, who do not wish to contribute to their own care?
• Financial fairness? – What is “fair”?  Who should pay? How much should they pay?
• Equity of provision across the UK? – How do we minimise variability in how legislation and policies are exercised between regions?

What are your views on funding for long term care? Join the debate.