Demens, samtykkekompetanse og rett til selvbestemmelse- utfordringer ved behandling og forskning

Abstract

Dementia, decisional capacity and the right to self-determination: Challenges in treatment and research: – Loss or reduction of decisional capacity is often an inevitable consequence of Alzheimer disease and other progressive dementias. This has legal as well as psychological and social implications. In this article we address loss of decisional capacity in light of the individual right to exercise self-determination as far as possible. This perspective is of particular importance to clinicians and researchers studying dementia and who need to determine whether a patient has the capacity to provide a valid informed consent to medical and psychological treatment and/or research. As the number of cognitively impaired elderly person’s increases, the need for valid and reliable assessment of their capacity to consent to treatment and research participation will grow. In terms of diagnosis, dementia implies cognitive deficits that in turn predict decisional impairment. Still, the question of whether a person has a decision-making competence is not to be decided by a diagnosis, but on the basis of an individual assessment. In the present paper, we discuss decision-making competence in terms of a multi-factorial cognitive process. In addition, we briefly review methods to ensure the validity of the consent and emphasize the need to further develop methods enhancing individual autonomy and self-determination in the process of giving consent.