ABSTRACT

The charge that advance directives are conceptually confused is often raised in the context of dementia. Alzheimer's disease is the most common and probably best known form of dementia, and I shall largely focus on this disease. Although the risk of suffering from Alzheimer's disease before age 65 is relatively small, the incidence may increase to about 50 percent in those aged 85 or more (Whitehouse 1992, p. 23). The symptoms of early Alzheimer's disease can be subtle. A person may feel somewhat disorganized at times and experience some mild loss of memory, without realizing that she is suffering from a progressive medical condition. As the disease progresses, symptoms will increase, accompanied by cognitive decline. Patients will eventually lose many of the characteristics that defined them as particular persons-their memories, their skills, the ability to sustain even simple projects or desires. They may be unable to recognize, and respond to, others and speech may be limited to a word or two. There is often incontinence, the patient may be unable to walk and to feed herself and will ultimately need total care (Office of Technology Assessment 1987; Whitehouse 1992). One care giver describes Alzheimer's disease as "a funeral that never ends" (Smith 1992, p. 49), and many others lament the fact that the patient they care for "is no longer the same person" he or she once was (Smith 1992, p. 46).