Can Someone With Dementia Make Medical Decisions?

Related to the last article, many people have the mistaken impression that patients with dementia are either not allowed, or are incompetent, to make medical decisions.

A person does not have to be “competent” to have medical decision-making "capacity".  Competency is something only a judge can decide, based on observations by one or more physicians; whereas medical decision-making capacity can be determined by a physician.

 

A person with dementia may be incompetent to manage their financial and other personal affairs but still have the capacity to make informed decisions about whether to have surgery, take prescriptions, or decline CPR.

In general, for anyone to make a truly informed consent, four elements of information must be provided:  1) the nature of the ‘procedure’ (what are they being asked to do); 2) the benefits; 3) the risks (whether common or severe ones); and 4) if there are any alternative treatments.  In addition, the consent must be voluntary; and the patient must have the capacity to understand what’s to be done.

Someone with dementia is only “incapacitated” in their decision-making ability if they cannot:  1) understand the nature of the procedure, 2) evaluate the information, 3) appreciate the consequences, 4) make a decision that’s consistent over time, or 5) communicate their decision.

Essential to this process is that the doctor/nurse must provide the information in a form understandable to the patient/family and allow them time to think about it.  Even though doctors’ recommendations are usually followed, studies also show that patients and their families still want adequate information so that they can feel comfortable making a shared decision with the physician.

Thus, in dementia, only those in the final stage (called a FAST Stage 7) are typically incapable of making most medical decisions.  When that stage is reached, if they have an Advance Directive in place, it will help avoid futile care or care they would not have wanted, and guide their Healthcare Proxy (or Durable Power of Attorney) in making decisions that are in the best interests of that patient.

All the staff employed by Hospice of the Shoals are well educated in this issue of capacity and can support families when needed.