Dementia and personhood: implications for advance directives

Dialogue on Ideal End-of-Life Care for Those With Dementia

“…However, situations change and the ethical balance shifts to distinguishing between the old (decisions made with clarity in a less stressful time) and the new (doubts that the person living in the final stages of dementia may not be the same as prior to the illness). Contrastingly, Moody 42 allows that the individual with dementia is still a person, in fact the same person who made the advance care plan. It is her view therefore that health care professionals should respect the precedent wishes knowing that there will be exceptions to this rule, but exceptions are what they must remain.…”

Legal and ethical issues associated with Advance Care Directives in an Australian context

“…During this time, the individual still experiences pleasure and pain but his/her memory, personality and behaviour may change. This raises the notion of personhood, questioning whether the apparent lack of psychological continuity renders an advanced dementia patient and his or her former self two different people . Many argue that individuals’ critical interests, those derived from their values and beliefs, are more enduring than their experiential interests, which encompass the activities they take pleasure in, as the latter may be altered by dementia .…”