Advance (Meta-) Directives for Patients with Dementia who Appear Content: Learning from a Nationwide Survey

Schoene-Seifert, Bettina; Uerpmann, Anna Lena; Gerß, Joachim; Herr, David W.

doi:10.1016/j.jamda.2016.01.014

Cited by 20 publications

(12 citation statements)

References 16 publications

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“…Finally, some have made an argument for valuing the patient's present autonomy overall as the most reflective of his happiness and true beliefs, that is, asking the patient with dementia if they are willing to undergo aggressive medical care. 19…”

Section: Case 3 Dementia and Unforeseen Consequences (Tales Of Brave mentioning

confidence: 99%

Emerging Ethical Challenges in Critical Care for the 21st Century: A Case-Based Discussion

Lee

Ward

2019

Semin Respir Crit Care Med

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Ethical challenges for doctors and other health care professionals have existed since the practice of medicine began. Many of the oldest challenges live on to this day, such as who has more authority to make key decisions (autonomy vs. paternalism) and what are the boundaries of life at the beginning and at the end. Two powerful driving forces are new technologies and an ever-changing culture and society. The practice of medicine in intensive care units (ICUs) has been the source of many ethical challenges. Once firmly fixed concepts, such as death or “brain death” are now coming under increasing debate. In other areas, the concept of patient autonomy has been used to request life-prolonging therapies, once thought “futile.” New technologies for procreation have necessitated new ethical challenges as well. In this paper, we will use a series of cases, based on experiences from our hospital ethics committee, that occurred over the course of several years and illustrate ethical challenges which are either new to us or not new but growing in frequency due to technological or societal changes. Each one of these topics is complex and worthy of its own large review but for this overview, we will briefly discuss the key points of each dilemma.

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Section: Case 3 Dementia and Unforeseen Consequences (Tales Of Brave mentioning

confidence: 99%

Emerging Ethical Challenges in Critical Care for the 21st Century: A Case-Based Discussion

Lee

Ward

2019

Semin Respir Crit Care Med

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“…She can, for instance, be happy or feel comfortable. That is one of the main reasons why physicians are sometimes reluctant to comply with advance directives (Schöne-Seifert et al, 2016). Because D can have mental properties, she must be different from the mindless human animal featuring in the radical objection.…”

Section: The Failure Of the Radical Objectionmentioning

confidence: 99%

In Defence of Advance Directives in Dementia

Witt

2019

Pacific Philosophical Qtr

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It has often been claimed that orthodox thinking about personal identity undermines the moral authority of advance directives in dementia by implying that the signer of the directive is numerically different from the severely demented patient. This is the ‘identity problem'. I introduce the problem, outline some well‐known solutions, and explain why they might be deemed unattractive. I then propose an alternative solution. It promises to be compatible with orthodox thinking about personal identity. I discuss three ways in which it might be challenged and find that none is convincing. Personal identity is no bar to the moral authority of advance directives.

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“…Although a majority in the general population and among health care professionals supports the rationale of advance directives, the applications on individual real life conditions are often not unequivocal. This lack of certainty is reflected by a recent empirical investigation showing that a substantial minority (about one quarter) of carers and health professionals would disregard an advance refusal of treatment [ 17 ]. A main reason for this disregard is the "past-directive versus present interests" dilemma: an executed advance treatment refusal for the case of later decisional incapability is in contrast to the positive emotional status of the demented patient in a medically critical situation [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…This lack of certainty is reflected by a recent empirical investigation showing that a substantial minority (about one quarter) of carers and health professionals would disregard an advance refusal of treatment [ 17 ]. A main reason for this disregard is the "past-directive versus present interests" dilemma: an executed advance treatment refusal for the case of later decisional incapability is in contrast to the positive emotional status of the demented patient in a medically critical situation [ 17 ]. Ethically it is also considered as questionable if an advance directive can be revoked by behavioural expressions after the loss of the decision-making capacity [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Advance directives for future dementia can be modified by a brief video presentation on dementia care: An experimental study

Volhard¹,

Jessen

Kleineidam

et al. 2018

PLoS ONE

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ObjectivesTo investigate whether life-sustaining measures in medical emergency situations are less accepted for an anticipated own future of living with dementia, and to test whether a resource-oriented, in contrast to a deficit-oriented video about the same demented person, would increase the acceptance of such life-saving measures.DesignExperimental study conducted between September 2012 and February 2013.SettingCommunity dwelling female volunteers living in the region of Bonn, Germany.Participants278 women aged 19 to 89 (mean age 53.4 years).InterventionPresentation of a video on dementia care focusing either on the deficits of a demented woman (negative framing), or focusing on the remaining resources (positive framing) of the same patient.Main outcome measuresApproval of life-sustaining treatments in five critical medical scenarios under the assumption of having comorbid dementia, before and after the presentation of the brief videos on care.ResultsAt baseline, the acceptance of life-sustaining measures in critical medical situations was significantly lower in subjects anticipating their own future life with dementia. Participants watching the resource-oriented film on living with dementia had significantly higher post-film acceptance rates compared to those watching the deficit-oriented negatively framed film. This effect particularly emerges if brief and efficient life-saving interventions with a high likelihood of physical recovery are available (eg, antibiotic treatment for pneumonia).ConclusionsAnticipated decisions regarding life-sustaining measures are negatively influenced by the subjective imagination of living with dementia, which might be shaped by common, unquestioned stereotypes. This bias can be reduced by providing audio-visual information on living with dementia which is not only centred around cognitive and functional losses but also focuses on remaining resources and the apparent quality of life. This is particularly true if the medical threat can be treated efficiently. These findings have implications for the practice of formulating, revising, and supporting advance directives.

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Advance (Meta-) Directives for Patients with Dementia who Appear Content: Learning from a Nationwide Survey

Cited by 20 publications

References 16 publications

Emerging Ethical Challenges in Critical Care for the 21st Century: A Case-Based Discussion

Emerging Ethical Challenges in Critical Care for the 21st Century: A Case-Based Discussion

In Defence of Advance Directives in Dementia

Advance directives for future dementia can be modified by a brief video presentation on dementia care: An experimental study

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