HealthDay News — Ethical considerations related to caring for patients with dementia are addressed in a position statement issued by the American Academy of Neurology and published in the July 13 issue of Neurology.
Winston Chiong, MD, PhD, from the University of California San Francisco, and colleagues discuss ethical considerations in dementia care and focus on applying ethical principles given changes across multiple domains, including understanding of disease and the crucial role of caregivers.
The authors emphasize that while communicating with patients and families, neurologists should acknowledge widespread misconceptions and clarify what they mean by dementia. Clinicians should ascertain how much information patients wish to receive prior to communicating a diagnosis and how they prefer to receive information. Unless patients who have the capacity specifically make a request that information deemed too devastating or harmful be given to others, nondisclosure violates patient autonomy, undermines trust, and may deprive patients of important opportunities to plan for future needs. Timely anticipatory planning in early stages is crucial to preserve autonomy over future decisions and reduce future strain on caregivers. Patients in the mild stages of dementia should be encouraged to discuss their overall goals with families and clinicians and execute advance health care directives. Patients who lack formal decisional capacity may be able to participate in decision-making in moderate stages of dementia.
“Caring for people with dementia requires respecting their autonomy and involving them in their care preferences as early as possible so their wishes can be known, while acknowledging their diminishing ability to make decisions,” Orly Avitzur, MD, MBA, president of the American Academy of Neurology, said in a statement. “This position statement offers guidance in accordance with core ethical principles, supporting the American Academy of Neurology’s mission to promote the highest quality patient-centered neurologic care.”