Inside the ethics committee. 3/4, Treating patients with dementia.

Radio documentary presented by Joan Bakewell about ethical dilemmas and discussed with the help of a panel. The programme deals with issues around the medical treatment of elderly patients with dementia. It looks at the case of a woman with the condition who is unable to make decisions for herself and who is fitted with a heart pace maker several years before developing dementia. Panellists James Beattie, a cardiologist at the Heart of England NHS Foundation Trust in Birmingham, and Liz Sampson, an old age psychiatrist and researcher at University College London, discuss the issues. The woman is eventually moved to a care home and as the condition deteriorates she frequently becomes aggressive towards her carers. Verbal communication becomes increasingly difficult and she is admitted to hospital with a fractured hip, finding the experience extremely distressing. The panel discusses the issues of treating physically frail people with dementia. Penny Lewis of the Centre for Medical Law and Ethics, King's College London joins the panel and they discuss the obligations of treating physical ailments of people with dementia who can't make their own decisions. After several years the battery in the pace maker needs replacing and due to the dementia this is not a straight forward procedure. The case is eventually presented to the Ethics Committee. The panel again discuss issues in relation to quality of life and advanced decisions, popularly known as living wills. The Ethics Committee make the decision that it would not be in the woman's best interests to have the pace maker battery changed. The cardiologist with responsibility for the final decision considers the advice, speaks to her family, and decides not to replace the battery.