Capacity and coercion: dilemmas in the discharge of older people with dementia from general hospital settings

Discharge planning of older people with dementia can present difficult ethical dilemmas to the general hospital clinician. These difficulties may be particularly pronounced for those who are moderately severely affected and for whom hazards are anticipated on discharge home. In many cases the wishes of the individual to return home may differ markedly from those of health care professionals, carers or relatives. In order to reduce these tensions and preserve the choice of the individual as far as possible, we try to put into context a number of different issues. We discuss some of the misconceptions regarding the legal powers available in these situations, the limited and sometimes confusing issue of capacity and the role of Community Mental Health Teams in preserving autonomy and independence of older people with dementia in their own homes.