Doing the Right Thing: A Geriatrician's Perspective on Medical Care for the Person with Advanced Dementia
Article first published online: 27 MAR 2012
© 2012 American Society of Law, Medicine & Ethics, Inc.
The Journal of Law, Medicine & Ethics
Volume 40, Issue 1, pages 51–56, Spring 2012
How to Cite
Gillick, M. R. (2012), Doing the Right Thing: A Geriatrician's Perspective on Medical Care for the Person with Advanced Dementia. The Journal of Law, Medicine & Ethics, 40: 51–56. doi: 10.1111/j.1748-720X.2012.00645.x
- Issue published online: 27 MAR 2012
- Article first published online: 27 MAR 2012
Developing a reasonable approach to the medical care of older people with dementia will be essential in the coming decades. Physicians are the locus of decision making for persons with dementia. It is the responsibility of the physician to assure that the surrogate understands the nature and trajectory of the disease and then to elicit the desired goal of care. Physicians need to ascertain whether any advance directives are available, and if so, whether they apply to the situation of advanced dementia. Finally, physicians should help surrogates understand how the goals of care are best translated into practice. When the goal is comfort, this is achieved by assuring dignity, minimizing suffering, and promoting caring. In general, comfort should be the default goal of care, best implemented through palliative care or hospice.