Michelle Mary Clare O'Brien1, Barbara Clyne2. 1. Gerontology Department, Beaumont Hospital, Beaumont, Dublin 9, Ireland. drmichelleobrien@gmail.com. 2. Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin 2, Ireland.
Abstract
BACKGROUND: The Assisted Decision Making (Capacity) Act 2015 in Ireland is designed to support and maximise a person's capacity to make decisions, although it has not yet commenced. Amendments to the legislation propose to deal with deprivation of liberty of persons lacking capacity. Health care professionals such as geriatricians will need to focus on enabling patient autonomy in response to legislative changes. AIMS: This study aimed to explore geriatricians' experience in a tertiary hospital setting when dealing with deprivation of liberty scenarios. METHODS: A generic qualitative study was undertaken in 2019 via 10 separate, semi-structured, in-person interviews with consultant geriatricians. The interview covered patient decision-making and deprivation of patient liberty in the acute setting, thoughts on proposed legislation and elements learned from experience. A thematic analysis was conducted. RESULTS: Regarding the potential deprivation of patient liberty, five themes emerged: (a) patient capacity, including assessment and opinions; (b) interaction of geriatricians with other professionals and dynamics amongst those that influence decision-making; (c) the environment of factors and frameworks shaping current practice; (d) medico-legal education and geriatricians recognising relevant, challenging cases; (e) the awareness of geriatricians of their attitudes and approaches, including reflecting on one's own practice. CONCLUSIONS: Results highlight a need for collaborative communication between doctors and legal professionals to achieve a structured and supportive framework to inform practice when working under any proposed legislation relating to deprivation of liberty.
BACKGROUND: The Assisted Decision Making (Capacity) Act 2015 in Ireland is designed to support and maximise a person's capacity to make decisions, although it has not yet commenced. Amendments to the legislation propose to deal with deprivation of liberty of persons lacking capacity. Health care professionals such as geriatricians will need to focus on enabling patient autonomy in response to legislative changes. AIMS: This study aimed to explore geriatricians' experience in a tertiary hospital setting when dealing with deprivation of liberty scenarios. METHODS: A generic qualitative study was undertaken in 2019 via 10 separate, semi-structured, in-person interviews with consultant geriatricians. The interview covered patient decision-making and deprivation of patient liberty in the acute setting, thoughts on proposed legislation and elements learned from experience. A thematic analysis was conducted. RESULTS: Regarding the potential deprivation of patient liberty, five themes emerged: (a) patient capacity, including assessment and opinions; (b) interaction of geriatricians with other professionals and dynamics amongst those that influence decision-making; (c) the environment of factors and frameworks shaping current practice; (d) medico-legal education and geriatricians recognising relevant, challenging cases; (e) the awareness of geriatricians of their attitudes and approaches, including reflecting on one's own practice. CONCLUSIONS: Results highlight a need for collaborative communication between doctors and legal professionals to achieve a structured and supportive framework to inform practice when working under any proposed legislation relating to deprivation of liberty.
Authors: Caroline Barry; Anna Spathis; Sarah Treaddell; Sally Carding; Stephen Barclay Journal: BMJ Support Palliat Care Date: 2017-04-24 Impact factor: 3.568