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Competency and consent in dementia

L K Fellows1

  • 1Department of Neurology, McGill University, Sir Mortimer B. Davis Jewish General Hospital, Montréal, Quebec, Canada.

Journal of the American Geriatrics Society
|July 22, 1998
PubMed
Summary
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Ethical decision-making for dementia patients requires a balanced approach. A sliding scale model of capacity respects patient autonomy while considering treatment risks, ensuring ethical care for older adults with cognitive impairment.

Area of Science:

  • Geriatric Medicine
  • Bioethics
  • Neuroscience

Background:

  • Dementia presents significant ethical challenges in healthcare, particularly concerning patient competency and decision-making capacity.
  • Social perceptions of dementia patients can influence judgments about their autonomy and ability to consent to treatment.

Purpose of the Study:

  • To propose an ethically grounded decision-making framework for individuals with dementia across all disease severities.
  • To review ethical principles for assessing treatment consent capacity in patients with cognitive impairment.

Main Methods:

  • Presentation of a sliding scale model for capacity assessment, balancing patient decision-making ability against treatment risks.
  • Contrast of 'prior competent choice' and 'best interests' standards for surrogate decision-making in incapacitated patients.
Keywords:
Mental Health TherapiesProfessional Patient Relationship

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  • Evaluation of the merits of these standards within the context of dementia care.

    • Main Results:

    • The sliding scale model aims to preserve patient autonomy while minimizing harm.
    • The 'best interests' standard focuses on the patient's current subjective experience, offering a way to affirm their sense of self.
    • Discrepancies exist between ethical/legal principles and actual decision-making practices in dementia care.

    Conclusions:

    • A coherent, ethically based decision-making process is crucial for dementia care.
    • The 'best interests' standard, despite challenges, provides a valuable approach for respecting the dignity and selfhood of patients with dementia.
    • Further examination of decision-making practices is needed to align with ethical and legal standards.