Dementia patients have the right to accept or refuse medical care so long as they demonstrate adequate mental capacity. The U.S. Constitution protects a person’s basic freedoms, including the right to privacy and protection against actions of others that may threaten bodily integrity. However, when a dementia patient’s mental capacity is shown to be inadequate, they no longer have the right to accept or refuse medical care.
Determining Competency in Dementia Patients
According to the law, patients who are presumed to be competent to make decisions have the right to accept or refuse medical treatment. However, patients who suffer from dementia and are proven to be incompetent to make important decisions about their health and well-being lose the right to accept or refuse medical care. The law endorses the principle that all persons are competent to make reasonable decisions unless proven otherwise.
Competency is a legal term that refers to a person’s ability to make informed, reasonable decisions. It is linked to a person’s cognitive capabilities and mental abilities to act in a rational, responsible manner. When a person lacks the ability to make sound decisions in his/her best interest, the court typically assigns a legal guardian to make decisions on that person’s behalf. To declare incompetency, the court requires medical evidence from a licensed physician or health care practitioner that shows medical evidence of incompetency. To ensure a person retains their basic rights, competency hearings often address specific tasks. Some people may be deemed competent to make certain decisions, but not others. In cases where patients are severely demented, intellectually disabled, psychotic, or in a vegetative state, it’s likely that the court would find them incompetent.
Most questions and concerns related to a patient’s competency arise when patients refuse medical care that a physician deems reasonable and necessary. Competency laws are established by individual states, and they may vary within different jurisdictions. Typically, states look at the several following factors when determining a patient’s competency.
The Ability to Make Rational Choices
A patient’s ability to make rational choices can be tested by asking if they understand what they have been told about their medical condition and care. If they do not, they may be deemed incompetent. Dementia patients who are not able to communicate decisions or preferences, change their decisions from moment to moment, or can’t make their wishes known are likely suffering from cognitive impairments that would prove incompetency.
The Ability to Understand Information
In every jurisdiction, courts look closely at a patient’s ability to understand basic information disclosed to them about their medical condition and care. Expressing a choice about a medical treatment has no meaning if the patient doesn’t understand what they are deciding. Dementia patients who can’t understand what they’re told about proposed treatments or diagnostic interventions are not capable of deciding whether to accept or refuse medical care. Patients suffering from significant problems caused by dementia are not able to exercise rational, reasonable judgment based on the information at hand. They cannot compare the benefits and risks of proposed treatment options or interventions.
The Ability to Assess the Situation
To evaluate competency, the court looks at a patient’s ability to assess his/her medical treatment and comprehend the benefits and risks of such treatment or care. Competency is not based on the patient’s ability to express preferences for care, but rather on the patient’s ability to evaluate the benefits and risks related to the quality of life. While one patient may be willing to accept serious risks over death, another may prefer death over the poor quality of life caused by the potential consequences of medical care. Many dementia patients are incapable of reasonably assessing the benefits and risks of their medical care.
Dementia and Nursing Home Neglect
Because dementia patients suffer from cognitive impairments that affect thought processes, reasoning skills, communication, and memory, they are at much greater risk for nursing home neglect and abuse. Studies show that dementia patients suffer higher incidents of verbal, physical, and sexual abuse in nursing homes and long-term care facilities.
The Centers for Disease Control and Prevention (CDC) shows there are approximately five million people over age 65 who have some form of dementia. At elderly nursing homes, patients with Alzheimer’s accounts for up to 80 percent of dementia cases. Alzheimer’s is a progressive disease with no known cure. In early stages of the disease, memory loss is minimal, but in late stages, patients suffer memory loss, as well as impaired reasoning and communication skills. These impairments make it impossible for dementia patients to communicate neglect and abuse with family members or nursing home caregivers and staff. Memory loss makes nursing home dementia patients frequent targets of elder neglect and abuse because many patients can’t remember specific incidents after they occur.