Decision-Making in Dementia - Essay Example

Running Head: DECISION MAKING IN DEMENTIA Decision Making in Dementia Name Institution Date Decision Making in Dementia Dementia with all its implications has come out in public awareness just within the last few decades, even though it has been acknowledged and treated by the medical community from as early as 19th century. As early as 1974, “dementia” is the term that was used by Maudesley to refer to impairment of memory (Livingston, 2006). From then, the cause, both the treatment and the required care of dementia has evolved considerably. At present, dementia is regularly characterised by numerous cognitive defects that consist of memory impairment without any impairment within consciousness. According to Karlawish 2008, the cognitive functions which could be affected by dementia, for instance are, common intelligence, discernment, learning and memory, problem solving, orientation, language, ruling and social capabilities, attention and concentration too. Thesis Statement The paper is aimed at exploring ways of ensuring that patients with dementia are allowed to make their own decisions. In situations where the conditions are severely worse, the decisions arrived at should be to the best interest of the patient. While dementia takes place as a result of several causes such as trauma, injury on the head, degenerative diseases of the nervous system, metabolic disorders in addition to other infections, the dementia that results from Alzheimer’s and vascular causes is the that accounts for about 75% of all known cases of dementia. The severity and widespread of economic and the social impact of dementia is so high that a latest news article in fact warned that the world is in danger of “Dementia Tsunami (Karlawish, 2008). At present, there are about more than 225,300 individuals with dementia in Australia and the number is anticipated to double by 2030 touching 475,000 and reaching as high as 730,000 by 2050. The association Alzheimer’s Australia forecasts that this could result to a loss of more than 150,000 carers in the next two decades except if intense changes within present policies are taken (Walker, 2009). Each and very person has the right to make his or her decision regarding things like the medical treatment to accept where to stay or live, as long as they are in a position to do that. This is also applicable to individuals with dementia too. As dementia progresses, nevertheless, it can get difficult for individuals to make their own decisions. Nevertheless, they should be allowed to make the slightest decisions they are able to (Karlawish, 2008). According to the law, it should always be held that a person is capable of making their own decision until it is indicated that they cannot entirely do it. And in case the decisions are made for individuals who do not have the ability to make their own decisions, such decisions should be in the individual’s ‘best interests’ or such a decision had the potential of ‘benefiting’ the person. Individuals suffering from dementia are supposed to be given the required support in order to assist them to in taking part in decisions as much as possible. If they are entirely not able to make decisions on their own, them they can still be in a position of making decisions mutually with trusted family or friends (Goulbourne, 2006). This means that instead of just making the decisions for a person with dementia entirely, it would only be fair to include them by ensuring that they participate in any decision regarding their care and life as well. This can be successfully done by the trusted family members and friends; this ensures that they are involved in making the decision and that no one solely makes their decisions without having them included. As a result, codes of practice that is made under the mental capacity Act and the adults with incapacity Act are supposed to lay emphasis on the importance of good communication in addition to supportive relationships with families and friends, so that mutual making is encouraged wherever suitable (Ferri, 2005). When the trusted family members are making decisions jointly with the affected member, it should be done to the best interest and the benefit of the person. In this effect, when deciding the correct thing to do; the past wishes and feelings of the individual in addition to the person’s wishes and feelings at present should be taken into consideration. Nevertheless, at times, past and present wishes can be relatively different. In this regard, both the current and the past wishes of the person are an expression of an individual’s autonomy and so they should be fairly respected (Scottish Executive, 2005). Additional advice is supposed to be offered within the mental capacity codes of practices regarding how the past wishes and preferences are supposed to be taken into consideration where they appear to contradict. Such advice should make emphasis that neither the past nor the current can involuntarily take preference. The comparative strength of the individual’s wishes, the level of importance of the decision and the amount of suffering being caused must all be important factors to be taken into consideration. This means that even if the person suffering from dementia is not in a position to make his or her decision, the decision that will be eventually made regarding their treatment or care will be somehow their inclination since his or her wish was considered while making the decision (Ferri, 2005). The number of individuals suffering from dementia within the United Kingdom is increasing and will reach one million in less that 20 years time. There is significant stigma regarding dementia and a common mistaken belief that an individual suffering from dementia cannot be engaged in decisions or offer their views while making important decisions (Shah, 2009). In the past, this assumption has been a barrier to individuals suffering from dementia assisting in the development of the health and social care system. The position statement “making decision” establishes the need to involve individuals with dementia while making decisions regarding their own care and treatment as well. In is now more and more acknowledged that being diagnosed with dementia does not imply that an individual is not in a position to share their point of view and have a say within the health and social care system. Accessing direct experiences of individual suffering from dementia is ever more possible because of the earlier diagnosis and the availability of drug treatments. According to Goulbourne 2006, this can make it easy for them to be involved in decision making Individuals suffering from dementia have been involved in the development of national policy, for instance, sitting on the working group that established the National Dementia Strategy for England and the NICE/SCIE dementia clinical guideline (Goulbourne, 2006). Their involvement in making such policies meant that significant decision-makers heard the voice and acknowledged individuals suffering from dementia and that the national policy echoed their concerns (Scottish Executive, 2005). Most of the prospects to enhance and improve life of the people with dementia within the National Dementia Strategy are the ones that individuals suffering from dementia suggested they needed or have found supportive. Such opportunities include increasing chances for peer support and better provision of information for individuals with dementia and their families as well. Shah, 2009, argues that, if their decisions were found to be important in the national policy it means that these people are in a position to make considerable decisions and thus their decisions are important as well especially when it has to do with their condition; dementia. The impairment in ability in addition to communication brought by dementia implies that an individual with dementia has special needs and at times will need additional support in order to take part meaningfully duties (Shah, 2009). The process should be cautiously designed to take into consideration individuals’ personal needs, for instance through provision of extra time during meetings in order to allow such people with dementia enough time to express their opinions, making use techniques like, visiting individuals with dementia within their own well-known and familiar environments (Shah, 2009). Both carers and family members of people with dementia can also offer important perception in participation work and should be included. Therefore, it is important to acknowledge that the perceptions of carers are different from the perspectives of individuals with dementia, but both are equally valid and vital. Cares are in a special position by knowing the individual with dementia prior to their condition (dementia) are having an understanding regarding how that individual may insinuate the services offered. They are over and over again able to articulate perceptions that their family members might not be in a position to articulate on their own behalf. Moreover, cares are regularly users of care and health services within their own right and therefore they are very important during decision making, especially of patients whose dementia condition has severally deteriorated (Davies, 2007). People with dementia can be involved in decisions regarding health and social care. The health and social care system essentially integrates a wide range of activities which consist of planning and designing services, delivering services, supervising how effective a service is and also researching on how such a service can operate in the future. Individuals using the services can and are supposed to be involved with each and very activity since this will ensure that their concerns and opinions are heard and as a result utilized in improving the system. As Davies 2007, suggests, there are various ways in which people can be engaged within health and social care and they include; participating in planning and decision-making regarding their services, taking part in consultations regarding new health and social care policies, giving feedback regarding the services they utilize, initiating and participating in research regarding their condition (Davies, 2007). Moreover, people can be involved by training the carers and staff on how best to offer the services and being included on control boards and working groups of health and social care organisations. According to Karlawish, 2008, if the people with dementia are involved in designing, deliverance, management and in monitoring of the health and social care system it will make sure that such individuals can shape and influence the health and social care service they utilize while being administered treatments and care as well. It is a fundamental part of putting the individual who makes use of the services at the core of the system; therefore, the people with dementia can have their representatives who will be actively involved in this essential part. Individuals with dementia have become gradually more involved within the work of Alzheimer’s society from 2000. Through a national program known as “Living with Dementia”, individuals suffering from dementia have been sharing their experiences, information and knowledge, and raising alertness of dementia at local and nationalized levels. This contribution is vital to make sure that Alzheimer’s society develops suitable information and support for individuals with dementia. Furthermore, it also makes sure that individuals with dementia can control the work that the Society does on their behalf. Individuals suffering from dementia are also strongly involved within the Alzheimer’s society’s research work. People with dementia work with established scientists in setting research objectives, awarding of grants and in evaluating the results. Wackerbarth, 2005, argues that this special involvement makes sure that the society finances research that will eventually have the greatest and best impact on the lives of the people with dementia. Individuals and organisations having the responsibilities of involving people should take care that their participation work is not just “tokenistic”. It is not enough to just include individual, for instance though inviting just a single person who makes use of the services to a meeting or by sending a consultation document to individuals who makes use of the services without availing the support and information they might need to respond. People with dementia should be actively involved, and on customary basis (Miles, 2006). It is vital that the services act in response to people’s opinions and insights regarding the services. There is a need to keep people with dementia informed regarding how their services are developed. They also need to know on how their opinions are being utilized in shaping the change, and in case their opinions are not taken into consideration, they need to be informed of the reasons behind that. Involvement should be seen as a part of a liaison and should be treated as a progressive dialogue, and not one-off conversation (Alzheimer Research Forum, 2008). Health and social care professionals are supposed to get valid consent from individuals with dementia before making any decision regarding their life, care or treatment. This is supposed to include informing the individual of alternatives, and checking and confirming that the person understands, there is no coercion whatsoever and that he or she continues to assent over time. In case the person with dementia does not have the ability to make the decision, the provisions of the Mental Capacity Act 2005 should be followed. Furthermore, health and social care professionals are supposed to inform individuals with dementia and their carers regarding advocacy services and voluntary support, and are supposed also to encourage their use while handling people with dementia. If needed, such services should be availed for both individuals suffering from dementia and their carers autonomously of each other (Hansen, 2006). People suffering from dementia should be offered the opportunity to communicate information to health and social care professionals involved within their care in a confidential way. In turn, health and social care professionals are supposed to discuss with the individual any necessity for the information to be shared with a colleague or other parties and agencies. Only in outstanding situations should the confidential information be disclosed to anyone else without the person’s approval. Nevertheless, as dementia deteriorates and the individual becomes more dependant on family or other carers, decisions regarding sharing information are supposed to be carried out in the framework of the Mental Capacity Act 2005 and its Code of Practice. In case the information will be shared with other people, it should be only done if it is in the best interests of the individual with dementia (Hansen, 2006). Health and social care professionals are supposed to discuss with the individual with dementia, when she or he has the ability and his/her carer regarding the usage of: health advance statements, which enables people with dementia to state and decide what will be done in case they afterwards lose the ability to make any decision or communicate, advance decisions to decline any treatment, lasting power of attorney, which is a lawful document that allows the person in dementia to state in writing the person they wan to make certain decisions on their behalf in case they are not in a position to make decisions for themselves and this includes decisions regarding individual health and wellbeing (Goulbourne, 2006). Finally, Health and social care professionals should also discuss with the person with dementia regarding the preferred place of care plan which enables such people to makes records of decisions regarding their future care preferences and the place where the individual would like to die (MRC General Practice Research Framework, 2006). With this, even if the person with dementia will in the long run not be in a position to make any decision regarding their care, future and his or her activities, he or she will have been involved in any decision regarding his/her life since he/he would have decided this in advance (Alzheimer Research Forum, 2008). The interests of the individuals with dementia in addition to of those who care for them should be promoted. First, there is the principle of self rule or autonomy. However, autonomy is not only about the likelihood of rational choice by people. Supporting valuable relationship to the person with dementia and supporting that person on top of supporting attempts to express the individual’s values is also important while handling a person with dementia. Promotion of the person’s autonomy should be balanced against the requirement to promote well being (Evans, 2005). This consists of the moment to moment experiences of satisfaction, in addition to the person’s level mental capacity or their degree of general health. Typical well-being in dementia is more dependants, mostly when the illness progresses, on making sure that well-being is sustained by small-scale moment to moment interactions and experiences too (Department of Mental Health Sciences, 2006). In conclusion, people suffering from dementia should be involved within the health and social care system to make sure the system is in a position to address and handle the requirements of these people. Organisations having the responsibility of designing, delivering and monitoring the health and social care system should actively involve individual with dementia. Individuals with dementia should be enabled to give their views and share their experiences. Furthermore, the people having the responsibility of involving individuals with dementia are supposed to use resources and tools for engaging individuals with dementia to participate in communal activities (Goulbourne, 2006). References Alzheimer Research Forum. (2008). AD research participation: informed consent complicates trials, part 1. < Available at: . Accessed 2nd October 2010. Davies S. (2007). ‘Making the best of things’: relatives’ experiences of decisions about care- home entry. Ageing Soc; 23:429-50. Department of Mental Health Sciences. (2006). The interests of the people with dementia. London: University College London. Department of Health. (2009). Living well with dementia: a national dementia strategy. London: DH. 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