Distinct attitudes of professionals from different medical specialties toward autonomy and legal instruments in the assessment of patients with Alzheimer's disease

Abstract

The evaluation of competence of Alzheimer’s disease (AD) patients to assume personal or collective responsibilities and the resulting legal implications is a relevant issue.ObjectivesThe aim of this study was to evaluate the attitudes of different medical specialists towards the disability of patients with Alzheimer’s disease and practitioners’ competence to interfere with decision-making autonomy.MethodsProfessionals from different areas (Neurology, Psychiatry, Geriatrics, and General Practice) were interviewed by one of the authors, after being presented a fictitious clinical case which raised several topics, namely:[1] Critical judgment and capacity of the patient to take decisions related to daily activities;[2] The role of family physicians in nominating trustees and caregivers.ResultsAnswers to the first question did not differ regarding degree of preservation of awareness but at least 25% stressed that the patient must be carefully listened to, independent of caregiver or legal representative opinion. There were significant knowledge gaps in responses to the second question. Half of the physicians interviewed did not have adequate information about the legal aspects of caring for patients with Alzheimer’s disease.ConclusionsLegal aspects is a topic that must be incorporated into professional training in order to improve attitudes toward the long-term management of patients with dementia.

A abordagem do envelhecimento na formação universitária dos profissionais de saúde: uma revisão integrativa

“…A conduta resolutiva diante das principais doenças que afetam os idosos, apontada como uma das competências necessárias aos profissionais, é destacada por dois dos estudos analisados. 9,10 Pioltini et al 9 …”

End of Life Care: Attitudes Toward Autonomy and Legal Instruments

“…The different attitudes of professionals from different medical specialties towards autonomy (Pioltini et al, 2010), and the family and physician´s views of surrogate decision making open a broad discussion about the role of different individuals in decision capacity assessment. The medical professional is more likely to listen to the patient and exchange ideas with colleagues, whereas the family tends toward consensus, assuming a shared position, which may or may not include the patient's wishes (Silberfeld et al, 1996).…”

“…The role of health personnel as an information staff is crucial in guaranteeing respect for the patient and preserving the principles manifested by him when healthy and able. In an inquiry presented to medical professionals from different specialties, only the geriatricians spontaneously called attention to the medical and legal aspects of patient injunction, highlighting the need for better disclosure of these aspects (Pioltini et al, 2010). Otherwise it will be no expectations that all older people are competent to take advanced procedure actions or directives to indicate a responsible person to assume decisions in their late moments of life.…”