| Dementia is an increasingly important problem in an aging society. Jewish and secular ethical theory and patient and caregiver narrative influence considerations of an appropriate response to the biomedical issues involving dementia. Dementia is a disease of dissolution and creates alienation of the person with dementia from self, others and God. It raises issues of theodicy for both people with dementia and their caregivers. Rabbinic texts deal with memory and forgetting but do not fully address the situation. There are many considerations in disclosure of diagnosis to the patient and his/her family including informed consent, which requires knowledge of one's diagnosis, prognosis and treatment options. Ruth Faden and Tom Beauchamp identify the following components of informed consent: diagnosis, comprehension, voluntariness, competence and consent. Lack of knowledge is lack of choice because there are still meaningful choices that a person with early stage dementia can make. The family of the person with dementia has responsibility to care for the person but it is not unlimited; this responsibility is explored in secular, biblical, talmudic, medieval and modern sources. There may be some circumstances that make it very difficult or impossible to continue to care for the patient at home; residential care may become necessary to preserve the health and sanity of family members. The conclusion-discusses patient and family interests and presents various views concerning advance directives and best interests. Marginalization, the concept of the person with dementia as other, creates excess disability (caused by social factors rather than neuropathology). Malignant social psychology, attitudes and behaviors that adversely affect the person with dementia, may be the result of ignorance rather than malice but it is harmful and impairs the solidarity between the cognitively normal and people with dementia. There is an affirmation of the value of all people, regardless of cognitive ability. |
