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Justice and the severely demented elderly.

D W Brock1

  • 1Department of Philosophy, Brown University, Providence, RI 02912.

The Journal of Medicine and Philosophy
|February 1, 1988
PubMed
Summary

This study examines healthcare justice for dementia patients. It argues that severe dementia erodes personal identity, limiting claims to palliative care, while moderate dementia warrants continued life-sustaining treatment.

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Area of Science:

  • Bioethics
  • Neuroscience
  • Public Health Policy

Background:

  • Dementia presents complex ethical challenges regarding healthcare allocation.
  • Existing frameworks for healthcare justice require re-evaluation in the context of cognitive impairment.

Purpose of the Study:

  • To analyze the ethical basis for healthcare claims in patients with severe cognitive impairment from dementia.
  • To differentiate between prudential allocation and interpersonal distribution in healthcare justice.
  • To determine the extent of healthcare rights for individuals with varying degrees of dementia.

Main Methods:

  • Philosophical analysis of justice theories applied to healthcare.
  • Examination of personal identity in relation to cognitive decline.
  • Distinction between palliative and life-sustaining treatment.

Main Results:

  • Patients who have died have no healthcare claims.
  • Prudential allocators would not sustain treatment for persistent vegetative states.
  • Severe dementia diminishes claims to life-sustaining care due to identity destruction.
  • Moderate dementia claims remain indeterminate under prudential allocation, suggesting continued care.

Conclusions:

  • Social policy should not deny life-sustaining care to moderately demented patients.
  • Ethical considerations for dementia care require nuanced approaches to healthcare justice.
  • The concept of personal identity is crucial in determining healthcare rights for cognitively impaired individuals.
Keywords:
Analytical ApproachHealth Care and Public HealthPhilosophical Approach

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