The ageing brain – proceedings of a medico – legal seminar, Editors: C. J. Vas, Charles Pinto, Dilip Panikker, Mumbai: Bandra, Holy Family Medical Research Society. 1997. 155 pages. Price not stated.

This collection of essays was I presented at a seminar organised on April 5 and 6, 1997, by the Dementia Research and Services Group; Bandra Holy Family Medical Research Society; FIAMC Bio-medical Ethics Centre, and the Aizheimer’s Disease and Related Disorders Society of India in Mumbai.

The need for a discussion focussing on medico-legal aspects of the care of patients with dementia has been felt for some time. Those working with such patients find the need for guidelines on such topics as the definition of dementia, who should be told of the diagnosis of dementia, how the stigma borne by other family members can be countered, how we can prevent relations from taking advantage of the dementing patient and how we can help individuals who have reason to fear the development of dementia in the future.

In order to clarify these and related issues, the organisers gathered a team of experts in medicine, law, administration, the social sciences and the media. Their presentations and the discussions that followed are embodied in this volume.

The first chapter consists of the inaugural address, by Dr. P.C. Alexander, governor of Maharahstra, who points to social factors that exacerbate the problems faced by the elderly-dementing patient. The number of individuals living beyond the age of 65 years doubled between 1971 and 1991 and is expected to reach 22 million by the end of the century. The joint family has almost become extinct.

Other factors: urbanisation with its attendantevils in the form of a fast pace of life, impersonal attitudes, the need for both spouses to earn (leaving ageing members of the family to themselves) and far from satisfactory and socially unacceptable institutional care.

The next section provides an orientation on the medical facts. Who is of sound mind? asks Dr Chicot Vas in this context, before going on to answer his own question, deriving the definition of dementia and how one can separate the legally competent from the incompetent. He also presents a brief review of law in India on the subject.

This review is followed by a more detailed analysis by Mr. P. M. Bakshi, former member-secretary of the Indian Law Commission. Mr.Bakshi provides comprehensive answers to such questions as who is qualified to determine competence of an individual, to whom should the diagnosis of dementia be disclosed, what is the process of determining a patient legally competent or incompetent, and who should be permitted to make decisions by proxy on behalf of individuals known to be mentally ‘deficient’.

The legal and medical aspects of competence are considered in further detail by two medical experts, a retired judge and a member of the law commission. An essay by Dilip Panikker and Charles Pinto discusses issues relevant to India.

Another area concerns the medical and legal requirements that must be met before a valid last will and testament can be drawn up. The definition of a *sound and disposing mind’, the steps to be taken by a doctor in determining that a given individual does, indeed, possess such a mind, and the manner in which a judge will rule on this issue are discussed in the essays by Dr. Walter Vas and Mr. Justice M. H. Kania. Essays on the medical and legal aspects of informed consent follow.

Session five deals with the power of attorney granted so that the interests of the demented person are safeguarded, how a living will may be made by a person under the threat of dementia and decision-making on behalf of the demented person.

The penultimate section deals with research on dementia (with special reference to India) and legal aspects of research in demented persons. The final section of the book provides a summary of the proceedings and recommendations made at the seminar.

The volume is attractive, well- designed and devoid of proof-reading errors. Colour photographs of speakers and panellists enable the reader to share the experiences of those fortunate enough to be in the conference hall. The text is subdivided into sections based on the actual sessions at the seminar. Brief notes on all the speakers at that session are provided at the start of each section. A summary of the presentations and discussions at the end of the session conclude each section.

The multidisciplinary approach at the seminar and close interactions between members of the medical and legal professions resulted in an outpouring of very useful information. The proceedings of the seminar provide important guidelines that will help all these working with demented individuals.- I have learnt much from this volume and strongly commend it