Deprivation of Liberty - What Would You do?

Dr Shane O’Hanlon

Consultant Physician in Geriatric and General Internal Medicine, St Vincent’s University Hospital

The recent case of A.C vs CUH & ors in the Court of Appeal has identified that there was no statutory or common-law power to detain a patient in hospital (outside of the application of the Mental Health Act 2001). See blog on this subject here:

https://drohanlon.wordpress.com/2018/07/03/first-thoughts-unlawful-detention-of-a-patient-with-dementia-in-hospital-in-ireland-a-c-vs-cuh-ors/

As it is likely to be a long time before any legislation is enacted to change this situation, it may be interesting to discuss how health professionals might approach the case below.

A 79 year old lady with mild cognitive impairment is admitted for an elective laparoscopic right hemicolectomy for colorectal cancer. The surgery goes very well but that evening the ward staff notice that she has become newly disoriented and a little agitated. This is initially helped by a cup of tea and reassurance but by 10pm she has started packing her bags and asking to leave.

The intern on call reviews her and notes normal observations. She is paranoid and has poor attention; the intern makes a diagnosis of acute delirium. The cause is not clear at this point. The patient wants to sign herself out but cannot understand the risks of leaving hospital. She starts walking towards the exit.

The intern asks for your help. What would you do?

 

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This is just a hypothetical case, so does not necessarily reflect how you would manage this situation in real life – but we would like to start a discussion…