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Advance directives and the severely demented
1Cleveland State University, Cleveland, OH 44115, USA. m.t.harvey@csuohio.edu
The Journal of Medicine and Philosophy
|February 9, 2006
Summary
Advance directives (ADs) can guide care for severe dementia, despite ethical concerns. A balanced approach using both ADs and a Best Interest Standard offers optimal decision-making for dementia patients.
Area of Science:
- Bioethics
- Neurology
- Geriatric Medicine
Background:
- Advance directives (ADs), such as living wills, present complex ethical considerations when applied to individuals with severe dementia.
- Rebecca Dresser's critique highlights theoretical incoherence and ethical dangers associated with using ADs for the severely demented.
- The Best Interest Standard is proposed as an alternative framework for making treatment decisions for patients with dementia.
Purpose of the Study:
- To evaluate the role of advance directives (ADs) in directing the care of severely demented individuals.
- To critically examine Rebecca Dresser's objections to the use of ADs in this population.
- To propose a balanced approach integrating ADs and the Best Interest Standard for dementia care.
Main Methods:
- Philosophical analysis of ethical arguments concerning advance directives and dementia care.
- Critical review of Rebecca Dresser's position on advance directives and the Best Interest Standard.
- Development of a compromise ethical framework for decision-making in severe dementia.
Main Results:
- Dresser's arguments against advance directives for severe dementia are found to be persuasive in principle.
- The Best Interest Standard offers a valuable framework for guiding treatment decisions in severe dementia.
- A compromise position suggests that both advance directives and the Best Interest Standard have utility.
Conclusions:
- Advance directives, while facing theoretical and ethical challenges, can play a role in the care of the severely demented.
- The Best Interest Standard is crucial for situations where advance directives are insufficient or inapplicable.
- An integrated approach, combining the strengths of both advance directives and the Best Interest Standard, is recommended for ethical dementia care.