Illustrative Cases

2021 ◽  
pp. 19-33
Keyword(s):  
Decision Making ◽  
Medical Aid ◽  
Decision Making Capacity ◽  
Aid In Dying ◽  
Food And Drink ◽  
Real Patients

Four stories of real patients who considered and then activated plans to voluntarily stop eating and drinking (VSED) are presented. Each had unique personal and clinical circumstances, but all wanted to know what “escape options” might be possible if their anticipated or actual suffering or deterioration became unacceptable to them. Most were initially unaware of VSED as a life-ending option until informed by the treating clinicians, and some were disappointed that they could not receive medical aid in dying, which they clearly would have preferred. The process of becoming aware and then ultimately choosing and completing VSED are explored. The prospect of losing decision-making capacity late in VSED and expressing a basic desire for food and drink should be anticipated and planned for. VSED was ultimately effective in helping these patients achieve a wished-for death, but the process was not without challenges.

Illustrative Cases

2021 ◽  
pp. 133-150
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Decision Makers ◽  
Decision Making Capacity ◽  
Challenges And Opportunities ◽  
Surrogate Decision Makers ◽  
Food And Drink ◽  
Surrogate Decision ◽  
Real Patients

Four stories of real patients considering VSED who would prefer to continue living until decision-making capacity is lost, and then have others start the stopping eating and drinking (SED) process on their behalf are described. Waiting until this stage potentially protects patients from having to initiate VSED before they really want to, but it also places considerable burdens on surrogate decision-makers who must activate the SED process based on the patient’s prior statements and formal advance directives (ADs). ADs for SED can help guide the timing, but a now-incapacitated patient who is very hungry and thirsty may not comprehend why he is not being provided food and drink. Patients and surrogates should consider in advance how to weigh statements of the “then-self” versus the “now-self” in subsequent decision-making. Four cases of SED by AD are explored, including some of the challenges and opportunities raised by allowing this possibility.

Legal Issues

2021 ◽  
pp. 204-228
Author(s):  
Thaddeus M. Pope
Keyword(s):  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Late Stage ◽  
Legal Issues ◽  
Home State ◽  
Decision Making Capacity ◽  
Food And Drink

This chapter analyzes a patient’s right to have food and drink withheld when they lack decision-making capacity. Authorization for this decision typically comes from the patient’s advance directive. Yet, because the relevant statutory language varies materially from jurisdiction to jurisdiction, so does the permissibility of stopping eating and drinking by advance directive. Individuals may be able to circumvent statutory obstacles by either (1) completing a non-statutory advance directive, or (2) completing an advance directive in a permissive state and having it recognized in their home state. Furthermore, even in permissive jurisdictions, there may be challenges in implementing the directive because some incapacitated individuals in late-stage dementia may make utterances or gestures that suggest they want food and water. Individuals may be able to resolve the contradiction between the wishes of their past self and their present self by including “Ulysses clause” language in their advance directives.

Issues of Capacity and Decision-Making in the Context of Delirium

2015 ◽  
Vol 24 (4) ◽  
pp. 140-145
Author(s):  
Kevin R. Patterson
Keyword(s):  
Decision Making ◽  
Patient Autonomy ◽  
Care Setting ◽  
Cognitive Change ◽  
Treatment Team ◽  
Precipitating Factors ◽  
Term Care ◽  
Decision Making Capacity ◽  
Fundamental Consideration

Decision-making capacity is a fundamental consideration in working with patients in a clinical setting. One of the most common conditions affecting decision-making capacity in patients in the inpatient or long-term care setting is a form of acute, transient cognitive change known as delirium. A thorough understanding of delirium — how it can present, its predisposing and precipitating factors, and how it can be managed — will improve a speech-language pathologist's (SLPs) ability to make treatment recommendations, and to advise the treatment team on issues related to communication and patient autonomy.

scholarly journals Using a multidisciplinary approach to reveal decision-making capacity within acute care for an individual with aphasia

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110270
Author(s):  
Ruth Maxwell ◽  
Michelle O’Brien ◽  
Deirdre O’Donnell ◽  
Lauren Christophers ◽  
Thilo Kroll
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Term Care ◽  
Multidisciplinary Team Approach ◽  
Decision Making Capacity ◽  
Health And Social Care ◽  
Functional Assessments ◽  
Health Nursing ◽  
Communication Approach

Formal assessments of cognition that rely on language may conceal the non-linguistic cognitive function of people with aphasia. This may have detrimental consequences for how people with aphasia are supported to reveal communicative and decision-making competence. This case report demonstrates a multidisciplinary team approach to supporting the health and social care decision-making of people with aphasia. The case is a 67-year-old woman with Wernicke’s type aphasia. As the issue of long-term care arose, the speech and language therapist used a supported communication approach with the patient who expressed her wish to go home. A multidisciplinary team functional assessment of capacity was undertaken which involved functional assessments and observations of everyday tasks by allied health, nursing, catering and medical staff. In this way, the patient’s decision-making capacity was revealed and she was discharged home. A collaborative multidisciplinary team approach using supported communication and functional capacity assessments may be essential for scaffolding the decision-making capacity of people with aphasia.

scholarly journals Decision-making capacity to address climate-induced food insecurity within women-led groups in Southern Mali

2021 ◽  
Vol 164 (3-4) ◽  
Author(s):  
Alexa L. Wood ◽  
Louie Rivers ◽  
Amadou Sidbé ◽  
Arika Ligmann-Zielinska
Keyword(s):  
Decision Making ◽  
Food Insecurity ◽  
Decision Making Capacity

The capacity to designate a surrogate is distinct from decisional capacity: normative and empirical considerations

2021 ◽  
pp. medethics-2020-107078
Author(s):  
Mark Navin ◽  
Jason Adam Wasserman ◽  
Devan Stahl ◽  
Tom Tomlinson
Keyword(s):  
Decision Making ◽  
Mental Illness ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Decisional Capacity ◽  
Risks And Benefits ◽  
Relative Risks ◽  
Decision Making Capacity ◽  
Cognitive Diseases ◽  
Surrogate Selection

The capacity to designate a surrogate (CDS) is not simply another kind of medical decision-making capacity (DMC). A patient with DMC can express a preference, understand information relevant to that choice, appreciate the significance of that information for their clinical condition, and reason about their choice in light of their goals and values. In contrast, a patient can possess the CDS even if they cannot appreciate their condition or reason about the relative risks and benefits of their options. Patients who lack DMC for many or most kinds of medical choices may nonetheless possess the CDS, particularly since the complex means-ends reasoning required by DMC is one of the first capacities to be lost in progressive cognitive diseases (eg, Alzheimer’s disease). That is, patients with significant cognitive decline or mental illness may still understand what a surrogate does, express a preference about a potential surrogate, and be able to provide some kind of justification for that selection. Moreover, there are many legitimate and relevant rationales for surrogate selection that are inconsistent with the reasoning criterion of DMC. Unfortunately, many patients are prevented from designating a surrogate if they are judged to lack DMC. When such patients possess the CDS, this practice is ethically wrong, legally dubious and imposes avoidable burdens on healthcare institutions.

scholarly journals 307 - Exploratory Study on Healthcare Decision-Making Capacity Assessment

2020 ◽  
Vol 32 (S1) ◽  
pp. 65-65
Author(s):  
Ana Saraiva Amaral ◽  
Rosa Marina Afonso ◽  
Mário R. Simões ◽  
Sandra Freitas
Keyword(s):  
Decision Making ◽  
Content Analysis ◽  
Focus Groups ◽  
Exploratory Study ◽  
Assessment Instrument ◽  
Funding Agency ◽  
Capacity Assessment ◽  
Healthcare Decision ◽  
Healthcare Decision Making ◽  
Decision Making Capacity

Mild cognitive impairment (MCI) and Alzheimer’s Disease (AD) prevalence is expected to continue to increase, due to the population ageing. MCI and AD may impact patients’ decision-making capacities, which should be assessed through the disease course. These medical conditions can affect the various areas of decision-making capacity in different ways. Decision-making capacity in healthcare is particularly relevant among this population. Elders often suffer from multimorbidity and are frequently asked to make healthcare decisions, which can vary from consenting a routine diagnostic procedure to decide receiving highly risk treatments.To assess this capacity in elders with MCI or AD, we developed the Healthcare Decision-Making Capacity Assessment Instrument (IACTD-CS - Instrumento de Avaliação da Capacidade de Tomada de Decisão em Cuidados de Saúde). This project is funded by Portuguese national funding agency for science, research and technology, FCT (SFRH/BD/139344/2018). IACTD-CS was developed based on Appelbaum and Grisso four abilities model, literature review and review of international assessment instruments. After IACTD-CS first version development, an exploratory study with focus groups was conducted. This study included focus groups with healthcare professionals and nursing homes’ professionals.The focus groups main goals were: 1) understand the participants perception regarding healthcare decision-making capacity, 2) distinguish relevant aspects of decision-making, 3) discuss the abilities and items included in IACTD-CS and 4) identify new aspects or items to be added to IACTD-CS. A content analysis of the focus groups results, with resource to MAXQDA, was conducted afterwards. This exploratory study allowed to identify professionals’ perceptions on healthcare decision-making and its results were a significant contribute to IACTD-CS development. The proposed communication aims to describe the methodology used and present the results of content analysis.

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