2012 AABHL Conference. Deciding for dementia patients – the challenges and responsibilities Kanny Ooi Bioethics Centre University of Otago. Background. Master of Bioethics & Health Law (MBHL) student at the Bioethics Centre, University of Otago.
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Deciding for dementia patients –
the challenges and responsibilities
University of Otago
Committee of the AABHL
John McPhee award
and to encourage scholarship in health law and ethics.
prolong life + postpone death
(despite severe and debilitating illness)
patient’s quality of life, cost of healthcare, next-of-kin’s views.
Attorney is able to reflect the donor’s wishes accurately and consistently.
In reality: This is not necessarily the case.
… despite patient choosing their proxy;
prior discussions between the proxy and patient.
People are “simply not very good at making substituted judgements for others, not even close relatives”.
Wrigley, A. (2007). Journal of Medical Ethics, 33(9): 527-531.
Assumes one’s mental processes behave the same way as the other person’s.
In reality, that may not be the case.
3. Emotional burden on proxy decision-maker
and can strain personal well-being and familial ties.
ranging from several months to a few years.
1.Better proxy-clinician communication
2.Identify and address stress factors for proxy
go some way in helping proxy avoid making unwise (treatment) decisions.
beneficial but invariably challenging (especially in a public hospital setting where there is a high demand for beds).
3. Earlier execution of Enduring Power of Attorney (EPOA)
4. Treat the dementia patient with respect
Key issue: Planning for care and treatment in the event of future incapacity.
Advance Care Planning
Rather than specific medical treatments alone.