chapter  45
16 Pages

End-of-life care and medical decision-making patients with dementia

Introduction Medical decision-making at the end of life of patients with dementia is a complicated matter, both medically and morally. First of all, a lot is still unknown on the natural course of the dementia process and its prognostic indicators. Also, it is often difficult to assess the reactions of dementia patients to diagnostic and therapeutic procedures because of difficulties in communication and uncertainty as to the adequacy of their expressions and the consistency of their opinions. In general, most demented patients in the more advanced stages of the disease lack the decisional capacity to contribute to decisions regarding their care and treatment, so physicians often have to resort to proxy decision-making, which has its own dilemmas and pitfalls.