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Acta Med Port. 2008 Jan-Feb;21(1):65-71. Epub 2008 Apr 18.

[Ethical and legal issues in late stage of dementia]

[Article in Portuguese]

Fernandes L.

Departamento de Psiquiatria, Hospital de S. João/Faculdade de Medicina da Universidade do Porto, Porto.

Abstract

As we enter the 21st century, growth of the elderly population, the costs of care, and the advances of medical

science and technology will continue to have an impact on the patient-physician relationship. Transformation of

the health care system will also raise ethical issues inherent to changing roles. The special nature of Alzheimer's

patients and the natural course of their disease require special care on the part of physicians to meet the ethical

challenges and establish medical goals, in conjunction with their patients and their families. In spite of these rapid

advances in biomedical sciences, were not sufficiently developed in the most fitness answers, regarding special

moral and ethical attitudes, which must be taken into account, in particular when we try to understand the

experience of people with dementia. This article explores emerging issues in relation to awareness in dementia

and its impact on legal and ethical matters. The different approaches and principles demonstrated in relation to

ethical issues are discussed, with an exploration of the concepts of mental capacity, testamentary capacity, power

of attorney, court of protection, advance directives, decision making, participation in research and treatment,

informed consent and older people driving. The tensions that exist between the imperatives of doing no harm and

of maintaining autonomy in addressing legal and ethical issues are highlighted. The review emphasizes the

importance of considering competency and awareness as being multi-faceted, to be understood in the context of

social interaction, trying to deal with the challenge of protecting, but not overprotecting, people with dementia.
Late stage of dementia is a terminal disease where the goal of the care may not be prolongation of life at all costs,

but rather achievement: quality of life, dignity and comfort. In the initial late dementia, quality of life is the target,

treating medical problems and psychiatric symptoms. The dignity of people with severe dementia will be

preserved, mostly when this influences patient's behaviour, maximizing individual Independence in daily living

activities. Finally, comfort is the last and the most important goal of care in late stages of dementia, using

appropriate medical strategies and eliminating aggressive interventions (cardiopulmonary resuscitation, acute

care setting, tube feeding and antibiotic treatment). The future work will focus on promoting more evidence-based

decision-making on treatment and guidelines for prognostic information. Physician must be knowledgeable about

broadly intersecting medical, legal, finance and ethics, underlying the long-term management of dementia.

PMID: 18489837 [PubMed - indexed for MEDLINE]Free Article

Publication Types, MeSH Terms

Publication Types:

• English Abstract

MeSH Terms:

• Dementia*
• Disease Progression
• Ethics, Clinical
• Humans
• Mental Competency*/legislation & jurisprudence

LinkOut - more resources

Full Text Sources:

• Centro Editor Livreiro da Ordem dos Medicos - PDF

Medical:

• Dementia - MedlinePlus Health Information

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