Lord Janner has been ordered to appear in court in person over child sex charges after a judge ruled his severe dementia should not prevent him standing in the dock.
Lawyers for the former Labour peer and MP said he was too ill to attend court in London today for a first hearing in the case and argued he may suffer a "catastrophic reaction" if made to appear in future.
But Senior District Judge Howard Riddle, the Chief Magistrate, ruled that Janner, who faces 22 charges spanning a period from the 1960s to the 1980s, did not have to understand or play a part in the initial hearing but was required by law to attend.
Judge Riddle adjourned the hearing to August 14, when Janner will have to attend, he said. He asked lawyers to investigate alternatives to Westminster Magistrates' Court, where it is due to take place, to reduce the "distress" caused. It was even suggested the case could be heard at the 87-year-old's home or a nearby building.
The judge heard evidence from two defence psychiatrists who said Janner was too ill to appear. But he ruled that while there was "absolutely no doubt" Janner had severe dementia, the hearing under Section 51 of the Crime and Disorder Act 1998 "does require the defendant's presence".
He said: "I have heard evidence from the two experts that in the context of today's hearing there is likely to be distress and that is what has been described as 'catastrophic distress'. But what it means, as I understand it, is that the defendant may well become intolerant of the process, irritable and may indeed leave.
"I further understand, and this is very significant, it is likely to have no long-term effect on him.
"He must appear for a comparatively short period of time. He is free to go if he becomes distressed. This (hearing) will probably be achieved in less than a minute. Nevertheless the law requires his presence."
Today's hearing came after an independent review in April overturned the original ruling of Director of Public Prosecutions (DPP) Alison Saunders that Janner should not be charged for alleged child sex crimes because of his Alzheimer's. She is the first DPP to have a major prosecuting decision reviewed and overturned through the new policy.
A trial of the facts, where a jury hears the evidence against an individual considered too ill for a full trial, is expected to be held into the charges against Janner, who was suspended by Labour in April.
A judge will have to decide if Lord Janner is fit to plead. If he is not, a jury will be asked to decide whether he did the acts he is charged with.
The judge will also have to rule on whether the defendant should appear during the trial or can be excused on medical grounds.
The peer's family strongly denies claims he used his power as an MP for Leicester to abuse vulnerable young boys at a local children's home.
Defence medical expert Norman Poole told the court former keen gardener Janner now "prefers to stay in a darkened room, watching television".
"Whenever they (his carers) encourage him to go out he resists and becomes quite challenging, saying 'no, no, no'," Dr Poole said, adding that Janner was not violent.
Dr James Warner told the court Janner's condition was "beginning to really impact on his day-to-day life", and that he was "highly likely to become distressed" in court and not understand what was happening.
Andrew Smith QC, for Janner, argued that the distress to his client would be "inappropriate and disproportionate to the process".
He added that alternative measures that might be considered by the court "do not in reality ameliorate the difficulties identified by the experts", including the duration of the hearing and the "alien" surroundings.
But Judge Riddle ordered Janner's attendance, while telling lawyers that "reducing distress to a minimum is important". He added: "I would encourage an imaginative approach to a situation I have not come across before."