An Examination of the Moral Authority of Use of Advance Directives with the Alzheimer's Dementia Population

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Date

2010-01-22T18:48:03Z

Authors

Sokolowski, Marcia

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University of Waterloo

Abstract

Advance directives in Canada are instructions made by capable adults that pertain to future healthcare treatment choices at a time of incapacity. My experience as an ethicist working in an Ontario long-term care facility that provides medical treatment to patients with Alzheimer’s Dementia portrays a range of important ethical concerns that arise out of the use of advance directives, at least in terms of their current use. In this thesis I analyze composite case studies to identify the more prominent challenges that exist and I turn to the literature to seek ways to more clearly understand these problems and to determine if they can be overcome. What I conclude is that the use of advance directives with the Alzheimer’s Dementia population in long-term care, as it is currently used, is fraught with problems that are mainly irresolvable. I offer clinical and policy recommendations that are aligned with this view.

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advance directives, living wills, autonomy, relational automony, Alzheimer's Dementia, competency, long-term care, informed consent, advance care planning, substitute decision-making

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