ETHICS AND LAWETHICS AND LAW

Guidelines for treating people suffering from A.D.

Ruth Goldberg

Delivering information concerning the disease

The ethical dilemma between:

Fear of the patient’s reaction in response to receiving the diagnosis.

Anticipated advantages the information gives the patient.

Recommendation (grade B level 3)

Information must be delivered after an extensive and thorough examination has determined a high likelihood that the diagnosis is correct.

Information regarding the diagnosis must be delivered with information concerning the prognosis, treatment options and support services.

How to deliver information concerning the diagnosis

Employ techniques of “Delivering bad news.”

Use the opportunity to discuss the patient’s concerns.

Identify with the patient.

Pay attention to the family dynamics.

The doctor closest to the patient should deliver the information.

Hold additional meetings to further discuss the disease.

Talk slowly, clearly and directly. Repeat information.

Deliver one message at a time.

Allow people to absorb information and ask questions.

Dementia patient’s competence

This is an important ethical issue because:

The denial of a person’s competence, in any field, is a severe blow to his autonomy.

Important capabilities for Competence

The ability to express one’s preference or choice.

The ability to understand the information relevant to the treatment.

The ability to rationally use the information.

The ability to assess the situation and its outcomes.

Sorts of competence

Competence to prepare a will.

Financial competence.

Competence to make medical decisions.

Grade B level 3) Recommendation)

A person suffering from A.D. will be involved in decisions, as long as possible.

Be attentive and sensitive to the messages that the patient is sending.

Encourage people to discuss their preferences decisions with family.

Encourage people to prepare Advanced Directives.

Driving

The diagnosis of dementia does not automatically entail that a person cannot drive.

No test can identify the exact moment a person suffering from A.D. can no longer drive.

The loss of the right to drive can be a difficult experience.

Decisions concerning competence in driving, will be gradual and initially temporary.

An “ all or nothing” stand must not be taken.

Recommendation (grade B level 3)

When driving is identified as dangerous, access to the car must be immediately restricted.

2 bodies give the final decision:Motor vehicle bureau’s national road safety medical institute.

Based on recommendation of an expert’s opinion.

The evaluation process

The driver will arrive for evaluation of his free will.

The doctor is responsible to transfer the relevant information.

The evaluation process requires the expert opinion of a specialist who conducted examination of the patient’s abilities.

The diagnosing doctor must determine if the process is temporary.

A Ct or MRI is not required.

The evaluation process will include a medical and behavioral history, and physical and neurological examinations.

A person with dementia, who has a guardian, will have his license revoked.

Patient’s license will be revoked with a score below 18/30.

The patient/family have the right to appeal

(with an opinion of a specialist).

In cases the doctor and referring party are not one, the patient’s guardian or caregiver are responsible.

The use of restrictive measures

Restrictive measures are use to restrict a person’s behavior or movement.

3 methods of restrictions:

Physical restrictive measures.

Pharmaceutical treatment.

Environmental restrictive measures.

Recommendation (grade b LEVEL 3)

:The use of restrictive measures should be

restricted.

Temporary and re-evaluated.

Take into consideration the following questions:

Have all other approaches been taken?

Is there a possibility of danger for the patient or the people surrounding him?

Have the potential risks of the treatment been considered?

Think about other opinions without restrictive measures as:

Search for patterns of behavior.

Consider change in the environment.

Living with certain behaviors must be expected.

Experience of other caregivers can help.

End of life treatment

The progressive character of A.D. disease raised unique issues concerning end of life treatment.

Decisions concerning end of life treatment must honor the wishes and preferences of the patient.

A good death is a relative term, which varies from person to person.

Advanced Directives

This is a legal document containing information concerning the person’s preferences for treatment, when he will not be able to make decisions.

Advanced Directives should indicate who is chosen to become a substitute decision maker.

Advanced Directives should be clearly phrased.

The family members should be aware of the Advanced Directives.

If no Advanced Directives were written, the people involved in making decisions, should consider the ideas of the patient’ before he was taken ill.

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