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Making Decisions About Life-Sustaining Medical Treatment in Patients With Dementia

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Abstract

The problem of decision-making capacity in patients with dementia, such as those with early stage Alzheimer's, can be vexing, especially when these patients refuse life-sustaining medical treatments. However, these patients should not be presumed to lack decision-making capacity. Instead, an analysis of the patient's decision-making capacity should be made. Patients who have some degree of decision-making capacity may be able to make a choice about life-sustaining medical treatment and may, in many cases, choose to forgo treatment.

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REFERENCES

  1. Miller DL, Jahnigen DW, Gorbien MJ, Simbartl L. Cardiopulmonary resuscitation: how useful? Attitudes and knowledge of an elderly population, Archives of Internal Medicine 1992; 152: 578–582.

    Google Scholar 

  2. Kuczewski MG. Reconceiving the family: The process of consent in medical decision-making, Hastings Center Report 1996; 26(2): 30–37.

    Google Scholar 

  3. Schloendorff v. Society of New York Hosp., 211 N.Y. 125, 129–130, 105 N.E. 92, 93 (1914).

  4. Salgo v. Leland Stanford, Jr. University Board of Trustees 154 Cal.App.2d 560, 317 P.2d 170 (1957).

  5. Canterbury v. Spence, 464 F.2d 772 (D.C. Cir. 1972), cert. denied, 409 U.S. 1064 (1973).

  6. Cruzan v. Director, Missouri Department of Health, 497 U.S. 261, 110 S.Ct. 2841, 58 U.S.L.W. 4916 (1990).

  7. Truman v. Thomas, 27 Cal. 3d 285, 611 P.2d 902, 165 Cal. Rptr 308 (1980).

  8. Derse AR. Consent: explicit and presumed-Patient refusal of emergency care. Autonomy and informed consent: Case commentary. In: Iserson K.V., Sanders AB, Mathieu D, eds. Ethics in Emergency Medicine. Tucson, AZ: Galen Press, 1995: 95–105.

    Google Scholar 

  9. Keeton WP, Dobbs DB, Keeton RE, Owen DG. Prosser and Keeton on Torts. 5th ed. St. Paul, MN: West Publishing Company, 1984: 117–118.

    Google Scholar 

  10. Menikoff JA, Sachs GA, Siegler M. Beyond advance directives – Health care surrogate laws. N Eng J Med 1992; 327: 1165–1169.

    Google Scholar 

  11. Roth LH, Meisel A, Lidz CW. Tests of competency to consent to treatment, Am. J. Psychiatry 1977; 134: 279–284.

    Google Scholar 

  12. President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Health Care Decisions, Vol. 1. Washington D.C.: U.S. Government Printing Office, 1992: 55–68.

  13. Buchanan AE, Brock DW. Competence and Incompetence. In, Deciding for Others: The Ethics of Surrogate Decision Making. Cambridge University Press. 1990: 17–86.

  14. Gert B, Culver CM, Clouser KD. Bioethics: A Return to Fundamentals, New York: Oxford University Press, 1997: 131–148.

    Google Scholar 

  15. Gallo JJ, Reichel W, Andersen LM. Handbook of Geriatric Assessment, 2nd ed. Gaithersburg, MD: Aspen, 1995: 11–68.

    Google Scholar 

  16. Jacques A. Understanding Dementia. 2nd. Ed., Edinburgh: Churchill Livingstone, 1992: 1–39.

  17. U.S. Department of Health and Human Services. Executive Summary: Values, goals, and trade-offs in the care of ADRD patients. Third Report of the Advisory Panel on Alzheimer's Disease. DHHS Pub. No. (ADM)92-1917. Washington D.C.: U.S. Government Printing Office. 1992.

    Google Scholar 

  18. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Washington, DC: The Association, 1994.

    Google Scholar 

  19. E.g. In re Quackenbush, 156 N.J. Super. 282, 383 A.2d 785 (1978), Lane v. Candura, 6 Mass. App. 377, 376 N.E.2d 1232 (1978).

  20. Folstein MF, Folstein SE, McHugh PR. Mini-mental state: A practical method for grading the cognitive state of patients for the clinician, J. Psychiatric Research 1975; 12: 189–198.

    Google Scholar 

  21. Mayeux R. Alzheimer's Disease, In Hazzard WR, Andres R, Beirman EL, Blass JP, eds. New York: Principles of Geriatric Medicine and Gerontology, 2nd Edition. 1990: 934–953.

  22. Kane RA, Kane RL. Assessing the Elderly: A Practical Guide to Measurement. Lexington MA: Lexington Books. 1981: 69–132.

    Google Scholar 

  23. Marson DC, Hawkins L, McInturff B, Harrell LE. Cognitive models that predict physician judgments of capacity to consent in mild Alzheimer's disease, Journal of the American Geriatrics Society 1997: 458–464.

  24. Marson DC, McInturff B, Hawkins L, Bartolucci A, Harrell LE. Consistency of physician judgments of capacity to consent in mild Alzheimer's disease, Journal of the American Geriatrics Society 1997: 453–457.

  25. Marson DC, Ingram KK, Docy HA, Harrell LE. Assessing the competency of patients with Alzheimer's disease under different legal standards, Arch Neurol 1995; 52: 949–954.

    Google Scholar 

  26. Dickens BM. Legal aspects of the dementias, Lancet 1997; 349: 948–950.

    Google Scholar 

  27. Post SG, Whitehouse PJ. Fairhill Guidelines on ethics of the care of people with Alzheimer's disease: A clinical summary, Journal of the American Geriatrics Society 1995; 43: 1423–1429.

    Google Scholar 

  28. Meisel A, Kuczewski M. Legal and ethical myths about informed consent. Archives of Internal Medicine 1996; 156: 2521–2526.

    Google Scholar 

  29. Drickamer MA, Lachs MS. Should patients with Alzheimer's disease be told their diagnosis? N Eng J Med 1992; 326: 947–951.

    Google Scholar 

  30. Ainslee N, Beisecker AE. Changes in decisions by elderly persons based on treatment description, Archives of Internal Medicine 1994; 154: 2225–2233.

    Google Scholar 

  31. Seckler AB, Meier DE, Mulvihill M, Cammer Paris BE. Substituted judgment: how accurate are proxy predictions? Annals of Internal Medicine 1991; 115: 92–98

    Google Scholar 

  32. Redelmeier DA, Rozin P, Kahneman D. Understanding patients' decisions: Cognitive and emotional perspectives, JAMA 1993; 270: 72–76.

    Google Scholar 

  33. Brock DW, Wartman SA. When competent patients make irrational choices, N Eng J Med. 1990; 322: 1595–1599.

    Google Scholar 

  34. Cassileth BR, Zupkis RV, Sutton-Smith JK. et al: Informed consent-Why are its goals imperfectly realized? N Engl J Med 1980; 302(16): 896–900.

    Google Scholar 

  35. Robinson G, Merav A. Informed consent: Recall by patients tested postoperatively, Ann Thorac Surg 1976; 22: 209.

    Google Scholar 

  36. Mezey M, Kluger M, Maislin G, Mittelman M. Life-sustaining treatment decisions by spouses of patients with Alzheimer's disease, Journal of the American Geriatrics Society 1996; 44: 144–150.

    Google Scholar 

  37. Hodges MO, Tolle SW, Stocking C, Cassel, CK. Tube feeding: internists attitudes concerning ethical obligations, Archives of Internal Medicine 1994; 154: 1013–1020.

    Google Scholar 

  38. Dresser R. Whitehouse PJ. The incompetent patient on the slippery slope, Hastings Center Report 1994; 24(4): 6–12.

    Google Scholar 

  39. Lynn J. Commentary on “In whose voice? Composing a life song collaboratively,” Journal of Clinical Ethics 1991; 2: 49.

    Google Scholar 

  40. High DM. Research with Alzheimer's disease subjects: informed consent and proxy decision making, Journal of the American Geriatrics Society 1992; 40: 950–957.

    Google Scholar 

  41. Roberts J. Oregon reaffirms assisted suicide, BMJ 1997; 315: 1253.

    Google Scholar 

  42. Shapiro RS, Derse AR, Gottlieb M, Schiedermayer DL, Olson M. Willingness to perform euthanasia: A survey of physicians attitudes, Archives of Internal Medicine 1994; 154: 575–584.

    Google Scholar 

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  1. Center for the Study of Bioethics, Medical College of Wisconsin, Milwaukee, WI, 53226-0509

    Arthur R. Derse

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Derse, A.R. Making Decisions About Life-Sustaining Medical Treatment in Patients With Dementia. Theor Med Bioeth 20, 55–67 (1999). https://doi.org/10.1023/A:1009928008193

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