Background In Switzerland, 51% of deaths are preceded by an end-of-life decision. Hospital health teams are frequently confronted with elderly demented patients having no more their discernment capacity and without advance directives. Recomposing these patients’ presumed will represents an ethical challenge.
Aim We propose a method applied by our interdisciplinary team of Geriatric Medicine, allowing to recompose these patients’ presumed will.
Methods Mr. H. suffers from dementia and he is hospitalised after a fall. He does not have his capacity of discernment and violently refuses the care. Family and health team are profoundly uneasy and ask themselves if the care plan is adequate. Applying an interdisciplinary bio-psycho-socio and spiritual model of care, each health team’s specialist carries out an assessment with the patient’s family members using questions arising from the model’s four dimensions. These assessments are confronted during an ethical debate aiming to recompose Mr. H. presumed will. The result is discussed with the patient’s family members to make a new care plan.
Results According to this decision, care plan is changed for palliative care.
Discussion Demented patients with no more discernment capacity have frequently no advance directives. In such cases, our solution is to recompose their presumed will with the family, a structured process during which many ethical questions can arise. This process is more complicated when family is absent or has conflict within members or with the health team.
Conclusion Using such a structured procedure often allows the health team to recompose the patient’s presumed will.
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