•

• Resources

• How To

kip to main content

kip to navigation

bout NCBI Accesskeys

My NCBISign In
PubMed
U.S. National Library of Medicine
National Institutes of Health

Search:

SearchClear

• Limits

• Advanced search

• Help

Display Settings:

• Abstract

Format

• Summary

• Summary (text)

• Abstract
 • Abstract (text)

• MEDLINE

• XML

• PMID List

Apply

Send to:

Acta Med Port. 2008 Jan-Feb;21(1):65-71. Epub 2008 Apr 18.

[Ethical and legal issues in late stage of dementia]

[Article in Portuguese]

Fernandes L.

Departamento de Psiquiatria, Hospital de S. João/Faculdade de Medicina da Universidade do Porto, Porto.

Abstract

As we enter the 21st century, growth of the elderly population, the costs of care, and the advances of medical

science and technology will continue to have an impact on the patient-physician relationship. Transformation of

the health care system will also raise ethical issues inherent to changing roles. The special nature of Alzheimer's

patients and the natural course of their disease require special care on the part of physicians to meet the ethical

challenges and establish medical goals, in conjunction with their patients and their families. In spite of these rapid

advances in biomedical sciences, were not sufficiently developed in the most fitness answers, regarding special

moral and ethical attitudes, which must be taken into account, in particular when we try to understand the

experience of people with dementia. This article explores emerging issues in relation to awareness in dementia

and its impact on legal and ethical matters. The different approaches and principles demonstrated in relation to

ethical issues are discussed, with an exploration of the concepts of mental capacity, testamentary capacity, power

of attorney, court of protection, advance directives, decision making, participation in research and treatment,

informed consent and older people driving. The tensions that exist between the imperatives of doing no harm and

of maintaining autonomy in addressing legal and ethical issues are highlighted. The review emphasizes the

importance of considering competency and awareness as being multi-faceted, to be understood in the context of

social interaction, trying to deal with the challenge of protecting, but not overprotecting, people with dementia.
Late stage of dementia is a terminal disease where the goal of the care may not be prolongation of life at all costs,

but rather achievement: quality of life, dignity and comfort. In the initial late dementia, quality of life is the target,

treating medical problems and psychiatric symptoms. The dignity of people with severe dementia will be

preserved, mostly when this influences patient's behaviour, maximizing individual Independence in daily living

activities. Finally, comfort is the last and the most important goal of care in late stages of dementia, using

appropriate medical strategies and eliminating aggressive interventions (cardiopulmonary resuscitation, acute

care setting, tube feeding and antibiotic treatment). The future work will focus on promoting more evidence-based

decision-making on treatment and guidelines for prognostic information. Physician must be knowledgeable about

broadly intersecting medical, legal, finance and ethics, underlying the long-term management of dementia.

PMID: 18489837 [PubMed - indexed for MEDLINE]Free Article

Publication Types, MeSH Terms

Publication Types:

• English Abstract

MeSH Terms:

• Dementia*
• Disease Progression
• Ethics, Clinical
• Humans
• Mental Competency*/legislation & jurisprudence

LinkOut - more resources

Full Text Sources:

• Centro Editor Livreiro da Ordem dos Medicos - PDF

Medical:

• Dementia - MedlinePlus Health Information

S
upplemental Content

Related citations

• Review Awareness in dementia: ethical and legal issues in relation to people with dementia. [Aging Ment Health. 2005]
 Review Awareness in dementia: ethical and legal issues in relation to people with dementia.

Woods B, Pratt R. Aging Ment Health. 2005 Sep; 9(5):423-9.

• [The origin of informed consent] [Acta Otorhinolaryngol Ital. 2005]

[The origin of informed consent]

Mallardi V. Acta Otorhinolaryngol Ital. 2005 Oct; 25(5):312-27.

• Review Ethical and legal issues in the care of Alzheimer's patients. [Med Clin North Am. 1994]

Review Ethical and legal issues in the care of Alzheimer's patients.

Caralis PV. Med Clin North Am. 1994 Jul; 78(4):877-93.

• Goals of care in advanced dementia: quality of life, dignity and comfort. [J Nutr Health Aging. 2007]

Goals of care in advanced dementia: quality of life, dignity and comfort.

Volicer L. J Nutr Health Aging. 2007 Nov-Dec; 11(6):481.

• Competency and consent in dementia. [J Am Geriatr Soc. 1998]

Competency and consent in dementia.

Fellows LK. J Am Geriatr Soc. 1998 Jul; 46(7):922-6.

See reviews... See all...

Recent activity

Clear Turn Off Turn On

• [Ethical and legal issues in late stage of dementia]

[Ethical and legal issues in late stage of dementia]

Acta Med Port. 2008 Jan-Feb ;21(1):65-71. Epub 2008 Apr 18 .

PubMed

• Quality of Life in Nursing Home Residents with Advanced Dementia.

Quality of Life in Nursing Home Residents with Advanced Dementia.

J Am Geriatr Soc. 2010 Nov 4. doi: 10.1111/j.1532-5415.2010.03170.x. [Epub ahead of print]

PubMed

• alzheimer's disease bioethics (71)

PubMed

• alzheimer's disease (74370)

 PubMed

• Critical care research on patients with advance directives or do-not-resuscitate...

Critical care research on patients with advance directives or do-not-resuscitate status: ethical challenges for clinician-investigators.

Crit Care Med. 2003 Mar ;31(3 Suppl):S167-71.

PubMed

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...

You are here: NCBI > Literature > PubMed

Write to the Help Desk

S
imple NCBI Directory
• GETTING STARTED

• NCBI Education

• NCBI Help Manual

• NCBI Handbook

• Training & Tutorials

• RESOURCES

• Chemicals & Bioassays

• Data & Software

• DNA & RNA

• Domains & Structures

• Genes & Expression

• Genetics & Medicine

• Genomes & Maps

• Homology

• Literature

• Proteins

• Sequence Analysis
• Taxonomy

• Training & Tutorials

• Variation

• POPULAR

• PubMed

• Nucleotide

• BLAST

• PubMed Central

• Gene

• Bookshelf

• Protein

• OMIM

• Genome

• SNP

• Structure

• FEATURED

• GenBank

• Reference Sequences

• Map Viewer

• Genome Projects

• Human Genome

• Mouse Genome

• Influenza Virus

• Primer-BLAST

• Sequence Read Archive

• NCBI INFORMATION

• About NCBI

• Research at NCBI

• NCBI Newsletter

• NCBI FTP Site

• NCBI on Facebook

• NCBI on Twitter
 • NCBI on YouTube

NIH DHHS USA.gov

Copyright | Disclaimer | Privacy | Accessibility | Contact

National Center for Biotechnology Information, U.S. National Library of Medicine 8600 Rockville Pike, Bethesda MD,

20894 USA