An Examination of the Moral Authority of Use of Advance Directives with the Alzheimer's Dementia Population

Abstract

Advance directives in Canada are instructions made by capable adults that pertain to future healthcare treatment choices at a time of incapacity. My experience as an ethicist working in an Ontario long-term care facility that provides medical treatment to patients with Alzheimer’s Dementia portrays a range of important ethical concerns that arise out of the use of advance directives, at least in terms of their current use. In this thesis I analyze composite case studies to identify the more prominent challenges that exist and I turn to the literature to seek ways to more clearly understand these problems and to determine if they can be overcome. What I conclude is that the use of advance directives with the Alzheimer’s Dementia population in long-term care, as it is currently used, is fraught with problems that are mainly irresolvable. I offer clinical and policy recommendations that are aligned with this view.