Dr. Feargal Twomey:

I am conscious of the comment the Deputy made a while ago. Some of the worst cases I have come across have been quite horrifying. Even in a milder setting, there are people who should have physical care and who should be washed, turned and minded but who are not. There are people whose money is being spent without their consent, and people whose views are being sidelined. Coercion is a huge problem. It comes back to a point I have made a number of times about our fear of death and dying. For example, a person might ask me not to tell their father he is dying, because he will turn his head to the wall. You often find out later on that in fact dad knows full well that he is dying, but it is the child, who might be in his 60s, who is struggling with the stress. I have had a couple of very difficult cases recently where the challenge has been managing the patient's expectation and on behalf of that, his family's oscillating expectation potentially that their father will live forever. Coercion can be elder abuse in some of the more recognised terms, but it can be much more subtle. It can affect vulnerable people with capacity, but certainly those who do not have capacity. The UK Mental Capacity Act 2005 was brought in to protect these people.