Vanilla Versus Chocolate Ice Cream
By Kathie Kane
Throughout our lives we develop preferences . We may prefer tea to coffee , warm weather as opposed to cold and chocolate ice cream over vanilla . Our preferences arise from our experiences . What if a person can ’ t always remember their preferences because of advanced dementia or Alzheimer ’ s Disease ? Will they still prefer chocolate ice cream ? They may still prefer the chocolate ice cream but what will it hurt to allow them to have the vanilla ice cream they insist on eating ? The individual will have been given a chance to exercise some autonomy and choice in the moment and probably be less agitated and happier as a result . Assessing and allowing this type of choice is part of the sliding scale of dementia and diminished capacity .
But what if the scenario is different ? Say an individual decides to cross a busy street and not wait for a traffic light to change or a crosswalk signal to safely cross . Should someone intercede to stop the unsafe action despite the individual ’ s desire to cross at that moment ? Absolutely ! This is simply another type of assessment connected to the concept of a sliding scale . It ’ s important to understand and remember that diagnosis alone doesn ’ t establish diminished capacity
Michael Gillette , in his plenary session , Ethics and Dementia , reminded everyone that just because a patient has been diagnosed with dementia , they still have the right to choose and to determine their care . Well-meaning family members and friends can often impose their beliefs and preferences on the individual without waiting to see if they have an opinion or assessing the level of harm in letting the individual ’ s decisions stand .
Caregivers need to understand and support the person ’ s “ previously expressed preferences .” As the disease progresses , a person ’ s ability to make decisions must be weighed against the safety or risk involved with those decisions . Each decision should be considered individually ; some actions may have grave consequences while others are simply inconvenient to the caregiver . Most people would hope to have their preferences respected even if they are experiencing dementia
Capacity is task specific , so incapacity must be assessed relative to the specific decisions at hand . People can maintain capacity in certain decisional areas while simultaneously lacking it in others .
The burden of proof rests on the party who would restrict the individual ’ s autonomy . Individuals have a right to control their own care . Further , if an individual lacks capacity in any area to safely make their own decision , the caregiver should default to what would be the person ’ s preference . Using the concept of a sliding scale of capacity in each situation can create an environment where people can still make decisions where cognitively able . They should be given the autonomy to choose the vanilla .
Block Party
Each year members , exhibitors , sponsors and LeadingAge New York staff look forward to the relaxing networking Block Party held outside the City Center . This year , the weather had other plans for participants and the party , which featured light fare and an open bar , was held indoors . But the move inside didn ’ t lessen the fun and camaraderie experienced by all .
35 Adviser a publication of LeadingAge New York | Summer 2017