[Autonomy and dementia Part II: autonomy and representation: a possible combination?]

Area of Science:

• Medical Ethics
• Gerontology
• Social Sciences

Context:

• Critically reviews medico-social literature on patient representation in dementia.
• Examines canonical versus relational perspectives on autonomy.
• Highlights limitations of the canonical view in dementia care.

Purpose:

• To question and re-evaluate patient representation concerning autonomy in dementia.
• To contrast the 'canonical' and 'relational' perspectives on autonomy.
• To propose a more balanced and inclusive model for decision-making in dementia.

Summary:

• The canonical view of autonomy, emphasizing rational decision-making by an independent self, struggles with dementia patients, as surrogates rely on past wills or present best interests.
• The relational perspective defines autonomy as a dialogue, with surrogates acting as present interlocutors, considering the patient's past and present self.
• This continuum allows for care continuity and a richer understanding of well-being for individuals with dementia, even when deemed incompetent.

Impact:

• Advocates for a relational model of autonomy to ensure better care continuity for dementia patients.
• Promotes a more balanced perspective on patient autonomy, recognizing its embeddedness in social relationships.
• Offers a richer framework for defining a good life until the end of life for individuals with progressive cognitive decline.