Some more about issues of restraint (follows from post on detention of patients with TB):
Laws which which were supposed to offer safeguards to the vulnerable elderly and people with learning difficulties have failed, experts have warned. The safeguards were introduced in 2009 in an attempt to stop the scandal of dementia patients being locked up and restrained in care homes and hospitals, without authority, or any checks that such measures could be justified.
Staff working with the elderly and those with learning disabilities now have to seek legal permission from special panels, if they intend to bring in measures which would reduce their freedom. The panels can only allow a "deprivation of liberty" if a formal assessment allows particular measures, finding that they are in the person's best interests. But a major study has found that the experts making such decisions cannot agree which kinds of cases require such legal protection.
The consultant psychiatrist at South London and Maudsley Hospital NHS Foundation trust said: "This legislation was introduced in order to safeguard and protect potentially vulnerable people; the problem is it is incredibly complex. If the professionals working in this field - including the expert lawyers - can't agree about what constitutes a deprivation of liberty, it is hard to have any confidence that the system is working."
The legal changes were triggered by a test case, when the European Court of Human Rights ruled in 2004 that a hospital was wrong to "informally" detain an adult patient with learning difficulties, and to deny him visits from foster parents, for fear they would take him home. In cases which are deemed to constitute a "deprivation of liberty" a hospital or care home has to have two experts formally assess a person, to judge what level of restriction is required, and the person is entitled to an independent advocate, and right of appeal.
Again this post raises the ethical problem of discerning the 'best interests' of the patient. How is it possible to decide this?