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Dementia is a collective term for cognitive disorders primarily affecting memory, thinking, and reasoning. It is not a specific disease but a syndrome, with Alzheimer's disease being the most common cause, accounting for approximately 60-80% of cases. Other types include vascular dementia, Lewy body dementia, and frontotemporal dementia. Dementia affects millions worldwide, particularly older adults, though it is not a normal part of aging.
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Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing
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On Avoiding Deep Dementia.

Norman L Cantor

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    |March 1, 2022
    PubMed
    Summary

    Individuals facing dementia can choose to stop eating and drinking or use advance directives to refuse life-sustaining treatment. Advance instructions for end-of-life care are lawful and moral, even in moderate dementia.

    Area of Science:

    • Bioethics
    • Neurology
    • Gerontology

    Background:

    • Alzheimer's disease and other dementias present significant challenges to quality of life.
    • Individuals have differing perspectives on confronting progressive cognitive decline and helplessness.
    • Protracted medical maintenance during severe dementia can be viewed as degrading by some.

    Purpose of the Study:

    • To explore strategies for avoiding prolonged dementia and its associated indignities.
    • To analyze the ethical and legal implications of advance directives for end-of-life care in dementia.
    • To determine the moral and legal permissibility of implementing advance instructions at moderate dementia stages.

    Main Methods:

    • Personal reflection and ethical analysis of end-of-life choices in dementia.

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  • Examination of strategies such as voluntarily stopping eating and drinking (VSED).
  • Analysis of advance instructions for rejecting life-sustaining treatment versus palliative care.

    • Main Results:

    • Advance instructions provide a preemptive strategy to avoid intolerable cognitive decline and helplessness.
    • Voluntarily stopping eating and drinking is presented as a method for self-deliverance before complete incapacitation.
    • Advance directives specifying nonintervention are deemed lawful and moral, even when the individual lacks capacity.

    Conclusions:

    • Implementing clear, considered advance instructions is a lawful and moral imperative for caregivers.
    • Advance directives can ensure patient autonomy and dignity at later stages of dementia.
    • The legal framework supports the implementation of advance directives for end-of-life decisions in dementia.