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Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy

Saturday, December 24, 2011

Patient Participation in Medical and Social Decisions in Alzheimer's Disease

By Johannes Hamann, MD; Katharina Bronner; Julia Margull; Rosmarie Mendel, PhD; Janine Diehl-Schmid, MD; Markus B├╝hner, PhD; Reinhold Klein, MD; Antonius Schneider, MD; Alexander Kurz, MD; Robert Perneczky, MD

From Journal of the American Geriatrics Society

The participation of patients in healthcare-related decisions is an ethical imperative that patient organizations and treatment guidelines promote. The mental health guidelines for most major psychiatric disorders, such as depression or schizophrenia, strongly recommend the inclusion of patients in all healthcare decisions,[1, 2] but Alzheimer's disease (AD) is an exception in this regard; although guidelines emphasize the disclosure of diagnosis and stress patient independence as a major aim, they consider impaired decisional capacity to be a limiting factor for patient participation at the same time.[3] Although AD is characterized by a cognitive decline that impairs the participation in medical decision-making,[4, 5] decisional capacity for important medical and social decisions might still be intact in patients in the early clinical stages of AD.[6] Important medical and social decisions that need to be made in these early stages are the introduction of an advance directive, a decision about driving, the initiation of antidementia treatment, and participation in clinical trials. Preventing patients from participating in these decisions not only reduces patient autonomy, but also risks ignoring the patients' will while they are still capable of making decisions, which might result in postponed decisions until decisional capacity has been lost.

The entire study can be found here.  In order to access the study, the reader needs to be registered with Medscape.  Registration is free.