Presentation is loading. Please wait.

Presentation is loading. Please wait.

IMPLEMENTING THE PRINCIPLE OF AUTONOMY IN DEMENTIA CARE

Published byCharlotte Pothier Modified over 6 years ago

Similar presentations

Presentation on theme: "IMPLEMENTING THE PRINCIPLE OF AUTONOMY IN DEMENTIA CARE"— Presentation transcript:

1 IMPLEMENTING THE PRINCIPLE OF AUTONOMY IN DEMENTIA CARE
To help anticipate To help live with dementia IMPLEMENTING THE PRINCIPLE OF AUTONOMY IN DEMENTIA CARE TRADUIRE LE PRINCIPE D’AUTONOMIE DANS LE SOIN AUX PERSONNES ATTEINTES DE DEMENCE Fabrice GZIL, PhD Manager, Social Studies Department FONDATION MEDERIC ALZHEIMER – Paris (France) 26th Conference of Alzheimer’s Disease International – 28th March Toronto (Canada)

2 Conflict of Interest Disclosure Fabrice Gzil, PhD
Has no real or apparent conflicts of interest to report.

3 CAPACITY FOR AUTONOMY AND DEMENTIA
Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 3 3

4 CAPACITY FOR AUTONOMY AND DEMENTIA
CLINICIANS Competence assessment field Can people with dementia consent to medical treatment or research? Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 3 4

5 CAPACITY FOR AUTONOMY AND DEMENTIA
CLINICIANS PHILOSOPHERS Competence assessment field Can people with dementia consent to medical treatment or research? Moral philosophy How is that capacity affected by dementia? Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 3 5

6 CAPACITY FOR AUTONOMY AND DEMENTIA
CLINICIANS PHILOSOPHERS Competence assessment field Can people with dementia consent to medical treatment or research? Moral philosophy How is that capacity affected by dementia?  Confronting the views of clinicians and philosophers Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 3 6

7 What is capacity for autonomy for CLINICIANS ?
Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 4 7

8 What is capacity for autonomy for CLINICIANS ?
Paul APPELBAUM Assessing decision-making capacity APPELBAUM & GRISSO. Assessing Competence to Consent to Treatment. Oxford University Press, 1998 Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 4 8

9 What is capacity for autonomy for CLINICIANS ?
Paul APPELBAUM Assessing decision-making capacity APPELBAUM & GRISSO. Assessing Competence to Consent to Treatment. Oxford University Press, 1998 A conceptual model of consent capacity based on US case law Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 4 9

10 What is capacity for autonomy for CLINICIANS ?
Paul APPELBAUM Assessing decision-making capacity APPELBAUM & GRISSO. Assessing Competence to Consent to Treatment. Oxford University Press, 1998 A conceptual model of consent capacity based on US case law Decision-making capacity is related to four abilities  UNDERSTANDING: ability to comprehend information  APPRECIATION: ability to relate this information to one’s own situation  REASONING: ability to evaluate and compare alternatives  EXPRESSING A CHOICE: ability to convey a relatively consistent choice Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 4 10

11 What is capacity for autonomy for CLINICIANS ?
Paul APPELBAUM Assessing decision-making capacity APPELBAUM & GRISSO. Assessing Competence to Consent to Treatment. Oxford University Press, 1998 A conceptual model of consent capacity based on US case law Decision-making capacity is related to four abilities  UNDERSTANDING: ability to comprehend information  APPRECIATION: ability to relate this information to one’s own situation  REASONING: ability to evaluate and compare alternatives  EXPRESSING A CHOICE: ability to convey a relatively consistent choice Clinical tools to assess consent capacity  MacCAT-T : MacArthur Competence Assessment Test for Treatment Decisions  MacCAT-CR : MacArthur Competence Assessment Test for Clinical Research Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 4 11

12 What is capacity for autonomy for PHILOSOPHERS ?
Ronald DWORKIN The ability to act out of a genuine character DWORKIN. Life’s Dominion: An argument about abortion, euthanasia and individual freedom. Alfred Knopf, 1993 The capacity to shape one’s life according to one’s distinctive personality Implies to have a sense of one’s whole life, "a past joined to a future" Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 5 12

13 What is capacity for autonomy for PHILOSOPHERS ?
Ronald DWORKIN The ability to act out of a genuine character DWORKIN. Life’s Dominion: An argument about abortion, euthanasia and individual freedom. Alfred Knopf, 1993 The capacity to shape one’s life according to one’s distinctive personality Implies to have a sense of one’s whole life, "a past joined to a future" Agnieszka JAWORSKA The capacity to value JAWORSKA. Respecting the Margins of Agency: Alzheimer’s patients and the capacity to value. Philosophy and Public Affairs 28(2), 1999 To be a ‘valuer’ is a sufficient condition to have capacity for autonomy Valuing may be quite independent of grasping the narrative of one’s life Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 5 13

14 CAPACITY FOR AUTONOMY AND DEMENTIA
CLINICIANS PHILOSOPHERS Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 6 14

15 CAPACITY FOR AUTONOMY AND DEMENTIA
CLINICIANS PHILOSOPHERS Capacity to make meaningful decisions Evaluated through specific tools (MacCAT-T, MacCAT-CR…) Capacity to have ‘critical interests’ or values More global capacity Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 6 15

16 CAPACITY FOR AUTONOMY AND DEMENTIA
CLINICIANS PHILOSOPHERS Capacity to make meaningful decisions Evaluated through specific tools (MacCAT-T, MacCAT-CR…) Capacity to have ‘critical interests’ or values More global capacity  Articulating the views of clinicians and philosophers Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 6 16

17 A ‘task-specific’ approach of competence
APPELBAUM A ‘task-specific’ approach of competence An assessment of independent decision-making capacity Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 7 17

18 APPELBAUM A ‘task-specific’ approach of competence An assessment of independent decision-making capacity JAWORSKA In the context of dementia, capacity for autonomy is best understood as the capacity to originate the appropriate bases for one’s decision that can be partly taken by others Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 7 18

19 APPELBAUM A ‘task-specific’ approach of competence An assessment of independent decision-making capacity JAWORSKA In the context of dementia, capacity for autonomy is best understood as the capacity to originate the appropriate bases for one’s decision that can be partly taken by others DWORKIN When the person has lost the capacity for autonomy, the critical interests which gave meaning and coherence to the person’s life are still important; one should try to respect them Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 7 19

20 … If no coherent sense of self
Can the person with dementia make this decision alone? … Uncertainty Is the person able to use information provided (understand, appreciate, reason) to express a choice? If not… Another person will make the decision, but the substitute decision-maker should consider the person’s current values … If no coherent sense of self Substitute decision-maker should consider the person’s precedent values and wishes(e.g. her advanced directives) Implementing the Principle of Autonomy in Dementia Care ADI Conference, Toronto, 28th March 2011 8 20

21 Thank you Merci for your attention de votre attention Fabrice GZIL

Download ppt "IMPLEMENTING THE PRINCIPLE OF AUTONOMY IN DEMENTIA CARE"

Similar presentations

ETHICS AND LAW Guidelines for treating people suffering from A.D. Ruth Goldberg.

ETHICS AND LAW Guidelines for treating people suffering from A.D. Ruth Goldberg.
DECISIONAL CAPACITY FEATURES STANDARDS TESTS AND CRITERIA.

DECISIONAL CAPACITY FEATURES STANDARDS TESTS AND CRITERIA.
A presentation to the AABHL Conference Auckland, July 2012 Alison Douglass, Barrister Lynne Bowyer, Bioethics Centre, University of Otago A Douglass and.

A presentation to the AABHL Conference Auckland, July 2012 Alison Douglass, Barrister Lynne Bowyer, Bioethics Centre, University of Otago A Douglass and.
Authority and Democracy

Authority and Democracy
ETHICS OF CONSENTING IMPAIRED INDIVIDUALS THERAPEUTICS Col Xolani Currie, Nat Dipl Rad, BA, HED, MPH Regulatory Oversight Manager Project Phidisa.

ETHICS OF CONSENTING IMPAIRED INDIVIDUALS THERAPEUTICS Col Xolani Currie, Nat Dipl Rad, BA, HED, MPH Regulatory Oversight Manager Project Phidisa.
Revised criteria for the Order of the Ministry. The personThe work  Qualifications ◦ 10 qualities anticipated in persons engaged in ministry in the CCDOC.

Revised criteria for the Order of the Ministry. The personThe work  Qualifications ◦ 10 qualities anticipated in persons engaged in ministry in the CCDOC.
HIPAA and Dementia: Balancing Privacy and Beneficence Tia Powell, MD Director, Montefiore Einstein Center for Bioethics.

HIPAA and Dementia: Balancing Privacy and Beneficence Tia Powell, MD Director, Montefiore Einstein Center for Bioethics.
EPECEPECEPECEPEC EPECEPECEPECEPEC Goals of Care Goals of Care Module 7 The Project to Educate Physicians on End-of-life Care Supported by the American.

EPECEPECEPECEPEC EPECEPECEPECEPEC Goals of Care Goals of Care Module 7 The Project to Educate Physicians on End-of-life Care Supported by the American.
The principles In Medical Ethics Lecturer :Noha Alaggad

The principles In Medical Ethics Lecturer :Noha Alaggad
Competency Assessment. Competency and Capacity Capacity/Competency –Legal, clinical, ethical and social construct –“Ability of an individual to make autonomous.

Competency Assessment. Competency and Capacity Capacity/Competency –Legal, clinical, ethical and social construct –“Ability of an individual to make autonomous.
Capacity Determination May 7 th, 2008 Alan Sanders, Ph.D. Director, Center for Ethics Saint Joseph’s Health System System Ethicist, Catholic Health East.

Capacity Determination May 7 th, 2008 Alan Sanders, Ph.D. Director, Center for Ethics Saint Joseph’s Health System System Ethicist, Catholic Health East.
Ethical and Legal Implications of Practice Chapter 5.

Ethical and Legal Implications of Practice Chapter 5.
The Chaplain as Spiritual Guide in Ethics Consults 2006.

The Chaplain as Spiritual Guide in Ethics Consults 2006.
Determining capacity and protecting subjects who have lost capacity Jason Karlawish, MD University of Pennsylvania.

Determining capacity and protecting subjects who have lost capacity Jason Karlawish, MD University of Pennsylvania.
Medical Ethics. Medical Ethics [vs. Professional ethics]  Ethical dilemma is a predicament in which there is no clear course to resolve the problem of.

Medical Ethics. Medical Ethics [vs. Professional ethics]  Ethical dilemma is a predicament in which there is no clear course to resolve the problem of.
Ethical Issues of Elder Care. Objectives Apply the concept of decision-specific capacity to older adults. Apply the concept of decision-specific capacity.

Ethical Issues of Elder Care. Objectives Apply the concept of decision-specific capacity to older adults. Apply the concept of decision-specific capacity.
Medical Decision Making Nuala Kenny SC, OC, MD, FRCP Department of Bioethics (post-rtd) Dalhousie University, Halifax, NS Ethics & Health Policy Advisor.

Medical Decision Making Nuala Kenny SC, OC, MD, FRCP Department of Bioethics (post-rtd) Dalhousie University, Halifax, NS Ethics & Health Policy Advisor.
Autonomy: Respect for Persons, Decision-making Capacity, & Informed Consent Walter Limehouse MD MUSC Ethics Committee Chair.

Autonomy: Respect for Persons, Decision-making Capacity, & Informed Consent Walter Limehouse MD MUSC Ethics Committee Chair.
Ethics and End-of-Life Care Part 2: Autonomy and Futility Michael Wassenaar, PhD February 9, 2012.

Ethics and End-of-Life Care Part 2: Autonomy and Futility Michael Wassenaar, PhD February 9, 2012.
Patient Understanding in Informed Consent Robert F. Dunton, MD Chief, Division of Cardiothoracic Surgery Upstate Medical University.

Patient Understanding in Informed Consent Robert F. Dunton, MD Chief, Division of Cardiothoracic Surgery Upstate Medical University.

Similar presentations

Ads by Google