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Plenary session - Legal and ethical issues in dementia

Abstracts and presentations

Legal problems experienced by people with dementia and their carers in Belgium

Philip Bentley, McDermott Will & Emery/Stanbrok LLP, Belgium,

This presentation will examine three broad categories of legal problems arising for people with dementia and their carers: the first, where civil law is inadequate or defective, and so ought to be changed; the second, where the solutions provided by law are probably as good as one can hope for, but this leaves pitfalls about which individuals should be forewarned; and last of all, the shortcomings of the social security system when it comes to indemnifying the costs of special medical and personal care required by persons with dementia.

These problems will be approached through a systematic review of the areas where legal issues specific to dementia arise, beginning with civil law liability for “fault”, capacity to contract and freedom to dispose of one’s assets, and leading into more sensitive issues such as appointment of an administrator and even placing the person concerned under enforced observation. In the medical area the additional legal safeguards required to protect persons with dementia will be examined in relation to consent to treatment, taking part in medical experiments, and the making of “living directives”. The presentation will round up by examining the social security and tax rules of particular relevance to persons with dementia, and the important issue of indemnification of individuals, usually relatives or close friends, who give up their employment, in whole or in part, in order to look after someone with dementia.

The Council of Europe recommendations on proxy decision making and advanced planning

Kees Blankman, Vrije Universiteit Amsterdam, Netherlands,

The Council of Europe seeks to achieve greater unity between the 47 member states, in particular by promoting adoption of common rules in legal matters. An instrument of growing importance for people with dementia and their families and carers is Recommendation No. 99(4) of the Committee of Ministers on principles concerning the legal protection of incapable adults. In a recent case the European Court of Human Rights concluded that these principles may define a common European standard in this area. The principles in this Recommendation not only deal with guardianship measures but also aimed at enhancing self-determination and autonomy. At the moment a second Recommendation is being prepared as an instrument complementary to the 99 Recommendation, especially focusing upon continuing powers of attorney and advance directives. These two methods provide capable adults with the possibility to plan for their own future incapacity. In several states in Europe legislation on continuing powers of attorney and advance directives has recently been passed or proposed.

The presentation will give an overview of the contents of both Recommendations and will demonstrate how they are in line with and promote initiatives on a national level in Europe. Both Recommendations, especially the second one, can be of great impact for the citizens in Europe, as will be argued by pointing out how they relate to the UN Convention on the Rights of Persons with Disabilities and the Hague Convention on the International Protection of Adult.

WPA Consensus Conference on Ethics and Capacity in older people with mental illness

Katona Cornelius, University College London, United Kingdom, on behalf of the World Psychiatric Association Consensus Conference participants,

The aim of the World Psychiatric Association consensus exercise on ethics and capacity in older people with mental illness was to provide practical guidelines to assist all those involved in ethical decision making relevant to this population. The consensus statement is informed by the principles of respect for the dignity and personhood of older people with mental illness, of maximizing autonomy, of acting for the benefit of patients and minimising harm, of justice and equity of resources, and of veracity. Equally important are the fundamental values of independence, safety and dignity, and the need to provide care and treatment aimed at optimizing function and wellbeing. Specific issues addressed in the consensus document include age-related stigma and discrimination, elder abuse and positive approaches to the assessment of capacity as well as end-of-life issues and the ethics of research in vulnerable older people.



Last Updated: Wednesday 21 October 2009