DISCUSSING DEGREES OF MENTAL DECLINE
When patients are experiencing problems
with senility and dementia at the end of their lives,
their proxies must make their medical decisions for them.
Different families (and/or proxies officially
appointed)
will use different criteria for making life-ending
decisions.
When would it be
appropriate to begin discussing
decisions that would bring this life to an end?
For the most conservative families,
there would never be
any point in mental decline
that would justify making life-ending decisions.
These families will keep their patients on life-supports indefinitely,
no matter how far they deteriorate.
If the body can be kept 'alive',
they will keep using medical technology to sustain it.
But most families and proxies see leeway to
make end-of-life choices.
And modern medical ethics and hospital policies
do allow families to make life-ending decisions
for patients who have deteriorated into hopeless conditions.
The most extreme examples of such decline would be
irreversible coma (permanent unconsciousness)
and persistent vegetative state (PVS).
For such conditions, little controversy remains.
The family and/or proxies can discontinue all forms of life-support
and allow the patient to die a natural death.
However, the in-between states of serious mental
decline
create for families the most difficult challenges for end-of-life
choices.
Just how far gone
must the patient be,
before it is time to consider medical decisions leading to death?
200 QUESTIONS FOR PROXIES
DISCUSSING DEGREES OF MENTAL DECLINE
Certainly, the family will seek all
appropriate medical information
and professional recommendations.
The deciders need to know the causes of the patient's condition.
And they should know the outcomes of any remaining treatment options.
They should ask the primary-care physician
for a
written
statement of the patient's condition and prognosis.
And in difficult cases, it might be wise to have a second
evaluation,
especially by a doctor trained in neurology,
when the medical issues focus on mental decline.
What is causing the deterioration of mental powers?
Can the problems be reversed or at least delayed?
Once the proxies (and/or family members)
have the medical facts and professional recommendations,
they will have to evaluate the degree of the patient's decline
based on their own
observations of the patient.
The following links lead to about 200 questions
that can be asked by laypersons about their relatives
who might be suffering serious mental decline.
These questions are divided into four areas:
1. Consciousness
2. Memory
3. Language & Communication
4. Autonomy
What signs of decline do we observe in each of these areas?
THE SEVENTEEN MOST IMPORTANT QUESTIONS:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/PER-QUES.html
This link leads to the key questions
for discussing the patient's levels of:
consciousness, memory, language, & autonomy.
WHEN IS A PERSON?
PRE-PERSONS & FORMER PERSONS
This small book (68 pages, free on the Internet)
explains each of the four
marks of personhood
before presenting the specific questions proxies can ask
to discuss the patient's levels of:
consciousness, memory, language, & autonomy.
The complete text of this book (including the 200 questions)
is available free of charge on the Internet:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/PERSON.html
If you would like a printed
copy of
When Is a Person? Pre-Persons
& Former Persons (2009 edition),
go to this link:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/PER.html
This
small book contains the most recent version of the 200 questions.
YOUR LAST YEAR:
CREATING YOUR OWN ADVANCE DIRECTIVE FOR MEDICAL CARE
The same 200 questions appear in a different context
in a book about 'living wills' or Advance Directives for Medical Care.
Quoting from this part of the table of contents:
PART
II.
Quality-of-Life Issues
81
Question
4:
What level of personhood
do you wish to preserve thru medical care?
When—according to your own criteria—
would you become a former person?
81
A. Questions for Proxies
about
Consciousness
and Self-Consciousness. 82
B. Questions for Proxies about
Memory.
84
C. Questions for Proxies about Language
and Communication. 85
D. Questions for Proxies about
Autonomy.
88
In Your Last Year,
the patient himself or herself
is encouraged to specify
in an Advance Directive for Medical Care
exactly how to evaluate his or her possible mental decline
as a background for making end-of-life decisions.
If the patient created a comprehensive Advance Directive,
this will make the decision-making process much easier for the proxies,
who must make all decisions after the patient has lost
the capacity to make wise and meaningful medical choices.
Here is the complete table of contents for Your Last Year:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/AD-OUT-NET.html
This link leads to many selections from the Your Last Year:
Creating Your Own Advance Directive for Medical Care.
At
the bottom of this table
of
contents for Your Last Year,
you will find information about obtaining your own copy
of this 264-page book encouraging you to create your own
comprehensive Advance Directive for Medical Care.
This book also includes the
author's own Answer to Question 4:
"What level of personhood
do you wish to preserve thru medical care?
When—according to your own criteria—
would you become a former person?"
And this Answer 4 is also available
free of charge on the
Internet:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/JP-LW.html
Scroll down to Question 4.
This Answer is two pages long.
And it has been revised for the printed version of Your Last Year.
Created February 9, 2009; revised
2-13-2009; 3-28-2009; 6-15-2009; 8-27-2009;
11-6-2010; 6-11-2011;
2-28-2012; 1-7-2013;
1-21-2015; 5-5-2016; 11-27-2017; 9-29-2018;
11-19-2019; 10-3-2020
See
related bibliographies:
Best
Books on Voluntary Death
Best
Books on Preparing for Death
Books
on Terminal Care
Books
on
Hospice Care
Books on Helping Patients to Die
Books
Supporting the
Right-to-Die
Books
Opposing
the Right-to-Die
Go to the Right-to-Die
Portal.
Return to the DEATH
page.
Go to the Medical
Ethics
index page.
Go to
the beginning of this website
James
Leonard Park—Free
Library