On euthanasia and other medical decisions in the terminal care of dementia patients

✍ Scribed by Dr. Tim Helme

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 617 KB
• Volume: 10
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/gps.930100902

✦ Synopsis

EDITORIAL COMMENT On Euthanasia and Other Medical Decisions in the Terminal Care of Dementia Patients Senile dementia is dr ,fact0 a chronic terminal illness. It is therefore curious that, whereas general adult psychiatrists such as John Hinton and Colin Murray Parkes have made important contributions to the study of bereavement and terminal care, old age psychiatrists have been largely silent on a subject which must always have constituted a significant part of our specialty. While the literature reveals occasional articles (eg Baker, 1976;Black andJolley, 1990, 1991;Richards and Lindesay, 1993), how many textbooks on dementia and old age psychiatry contain a chapter on terminal care? Perhaps many psychiatrists feel that the care of the dying is only tangential to their area of special expertise and therefore best passed back to general practitioners. The gradual closure of National Health Service long-stay psychiatric facilities may lend support to, or possibly may merely be a reflection of, such an attitude. An alternative explanation is that the suggestion that terminal care constitutes a core part of the practice of psychogeriatrics raises conceptual and forensic problems which are seen as morally difficult, emotionally taxing and clinically timeconsuming.

Richards and Lindesay began their paper describing their survey on terminal care in old age psychiatry with the following comments: 'Few clinical decisions are more difficult than whether or not to withhold treatment from patients who are unable to make this choice for themselves. This is because they bring into conflict a number of principles central to clinical practice, such as the duty to save life, the duty to relieve suffering, and the duty to heed patients' wishes.' This article will expand on that conceptual conflict within the developing ethical debate (Stanley, 1992;Walton, 1994