LeadingAge New York Annual Conference 2017 June 2017 | Page 10
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.
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Adviser a publication of LeadingAge New York | Summer 2017