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Psychiatric Bulletin (2002) 26: 436. doi: 10.1192/pb.26.11.436-b
© 2002 The Royal College of Psychiatrists
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Psychiatric Bulletin (2002) 26: 436
© 2002 The Royal College of Psychiatrists

Correspondence

Medico-legal implications of drug treatment in dementia

Shokoufa Manouchehri Kashani and Julian C. Hughes

Gibside Unit, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne NE4 6BE

Sir: We read with interest the paper by Lawrence et al (Psychiatric Bulletin, June 2002, 26, 230-232), which was both informative and timely.

However, in discussing the difficulties encountered in obtaining consent in dementia, they state that the alternatives to valid consent ‘such as assent or vicarious approval by a carer, are unlikely to satisfy legal or moral requirements’. We disagree because these are not the only alternatives.

If an adult patient cannot give valid consent, because he or she lacks capacity, doctors must act in the person's ‘best interests’. Of course, this does not simply mean best medical interests. As the Lord Chancellor has reminded us, ‘best interests’ are determined by broad and careful discussion and negotiation (Hughes, 2000). Decisions arising from such a process of open collaboration and mutual engagement will have both a legal footing and ethical basis.

References

HUGHES, J. C. (2000) Ethics and the anti-dementia drugs. International Journal of Geriatric Psychiatry, 15, 538-543.[Medline]





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