Antipsychotic medications in dementia – time to think again about regulation?

Along with my colleague, Elizabeth Peel, I was invited to write a post for the OUP Blog highlighting the arguments in a paper of ours that was recently published in the Medical Law Review. The blog post draws out several of the arguments from our paper (which is open access for a short period: download it now!), and yet no-one seems to have taken much notice. When we were invited to write for the blog, we were told that the blog has 8,000 subscribers and has over 40,000 visits every month. So why would a contribution on this important issue not make much of a splash?
There could be all sorts of reasons – perhaps it’s not quite on the zeitgeist of where the media focus is on caring for people living with dementia; perhaps the argument in the paper is too ‘legal’ and so not quite amenable to media interest in the blogosphere; perhaps the recently reported reduction in antipsychotic prescribing makes everyone think this is a non-issue; or perhaps until there are other ways to ‘treat’ ‘challenging behaviour’ in dementia, nobody is interested in the limitations of the current methods. It’s hard to tell. Certainly any and all of these might be contributory factors. But I think this is an important issue, and one that it’s worth shouting about, so I’m going to try again here!
In the article ‘He was like a Zombie’: Off-label prescription of antipsychotic drugs in dementia’, we argue that most antipsychotic drugs:

  • are not tested for use in elderly people with dementia;
  • are not licensed for use in elderly people with dementia;
  • have serious side effects including stroke and death when prescribed to elderly people with dementia
  • should be better regulated

We also highlight that in our empirical research, carers of people with dementia report a range of other harms associated with the use of this class of drugs to treat behavioural symptoms in the people they care for. In the paper, we explore the potential for legal redress for these harms and find that there is little or no chance of legal claims being successful.
As we think again about how people who can’t stand up for themselves are vulnerable to abuse at the hands of the professionals responsible for their care (for example the Winterbourne View scandal), we need to think again about all sides of the interface between care, law and regulation. The current regulatory frameworks offer little comfort to those who are harmed by ‘care’ that is not criminally abusive. So as well as thinking again about how we regulate social care, I think the antipsychotics issue demonstrates why we might also need to think again about health care and those who can’t consent to treatment. Without going into the intricacies of medical negligence, people with dementia harmed by the prescription of antipsychotic drugs to treat behavioural symptoms currently have no chance of compensation or access to justice even though it is widely known that they can be harmful. I think it is time this changed. What do you think?

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About Rosie Harding

Prof Rosie Harding is Professor of Law and Society at the University of Birmingham. Rosie studied for an LLB at the University of Edinburgh, an LLM at Keele University and a PhD at the University of Kent. She was PI on the AHRC-funded phase of the ReValuing Care Network. Her research explores the place of law in everyday life with a particular focus on the recognition and regulation of caring and intimate relationships. Her broader research interests are in family law, healthcare law, disability law and gender, sexuality and law. She is the author of Duties to Care: Dementia, Relationality and Law (2017, Cambridge University Press) and Regulating Sexuality (2011, Routledge winner of the 2011 Hart-SLSA Book Prize and Early Career Prizes), and editor of ReValuing Care in Theory, Law and Policy: Cycles and Connections (2017, Routledge, with Ruth Fletcher & Chris Beasley), Law and Sexuality (2016, Routledge Critical Concepts in Law), and Ageing and Sexualities: Interdisciplinary Perspectives (2016, Ashgate; 2016, Routledge, with Elizabeth Peel). Rosie is a 2016/17 British Academy Mid-Career Fellow, working on ‘Everyday Decisions: Interrogating the interface between mental capacity and legal capacity’.  She founded and co-ordinated CentreLGS PECANS (http://www.clgs-pecans.org.uk/), from 2004-2011. PECANS is an international and interdisciplinary network of early career scholars working in the law, gender and sexuality field. PECANS was funded by the AHRC CentreLGS from 2004-2009, and the ESRC from 2009-2011.

Telephone :-+44 (0) 121 414 4960

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