Journal Article

Narrative Interest Standard: A Novel Approach to Surrogate Decision-Making for People With Dementia

James M Wilkins

in The Gerontologist

Published on behalf of The Gerontological Society of America

Volume 58, issue 6, pages 1016-1020
Published in print November 2018 | ISSN: 0016-9013
Published online June 2017 | e-ISSN: 1758-5341 | DOI: https://dx.doi.org/10.1093/geront/gnx107
Narrative Interest Standard: A Novel Approach to Surrogate Decision-Making for People With Dementia

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  • Geriatric Medicine
  • Biological Sciences
  • Psychology
  • Care of the Elderly
  • Gerontology and Ageing

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Abstract

Dementia is a common neurodegenerative process that can significantly impair decision-making capacity as the disease progresses. When a person is found to lack capacity to make a decision, a surrogate decision-maker is generally sought to aid in decision-making. Typical bases for surrogate decision-making include the substituted judgment standard and the best interest standard. Given the heterogeneous and progressive course of dementia, however, these standards for surrogate decision-making are often insufficient in providing guidance for the decision-making for a person with dementia, escalating the likelihood of conflict in these decisions. In this article, the narrative interest standard is presented as a novel and more appropriate approach to surrogate decision-making for people with dementia. Through case presentation and ethical analysis, the standard mechanisms for surrogate decision-making for people with dementia are reviewed and critiqued. The narrative interest standard is then introduced and discussed as a dementia-specific model for surrogate decision-making. Through incorporation of elements of a best interest standard in focusing on the current benefit–burden ratio and elements of narrative to provide context, history, and flexibility for values and preferences that may change over time, the narrative interest standard allows for elaboration of an enriched context for surrogate decision-making for people with dementia. More importantly, however, a narrative approach encourages the direct contribution from people with dementia in authoring the story of what matters to them in their lives.

Keywords: Dementia; Quality of life; Ethical issues; Decision-making

Journal Article.  3879 words. 

Subjects: Geriatric Medicine ; Biological Sciences ; Psychology ; Care of the Elderly ; Gerontology and Ageing

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