A Comparative Analysis of the Treatment of Decision-Making by or for Patients with Neurodegenerative Diseases in Four Legal Jurisdictions

Abstract

Dementia is associated with the gradual impairment of mental ability. The population of people suffering from dementia is as large as 50 million. Most dementia cases result from various neurodegenerative diseases (NDs) linked by a progressive degeneration of neurons. Among NDs, Alzheimer's disease (AD) is the most frequent cause of dementia and accounts for 60-80% of cases. Certain pathological changes on the cellular and subcellular level occur even 15 years before the manifestation of clinical symptoms of AD. This first asymptomatic phase of AD is considered a preclinical stage, whereas mild cognitive impairment (MCI) is the symptomatic pre-dementia stage. The third, fully symptomatic phase of AD is dementia due to AD. The presence of specific proteins in the cerebrospinal fluid (CSF) may be considered as a characteristic feature of some NDs. The measurement of their CSF concentrations, together with neuropsychological examination and neuroimaging, may be useful for diagnosing AD. The collection of CSF samples is performed by lumbar puncture, which is a medical procedure that requires obtaining informed consent from patients. While asymptomatic AD patients have full legal capacity, those with dementia require a legal guardian who will represent them. Thus, the objective of this study is to compare the legal systems regulating the legal capacity issue in the USA, U.K. (England and Wales), Germany, and Poland. These countries have been chosen as examples of three different types of legal orders, according to the sources of law, i.e., civil law, common law, and case law.

CXCL-8 in Preoperative Colorectal Cancer Patients: Significance for Diagnosis and Cancer Progression

“…This means that, in general, the patient's consent is required to carry out the medical procedure. It is crucial in the case of cancer when the quality of the decision to choose an effective treatment method is influenced by a reliable diagnosis [18,19].…”

The Role of Selected Chemokines and Their Receptors in the Development of Gliomas

“…However, the biomarker occurrence in CSF might result not only from the secretion or leaking by tumor tissues, but also from dysfunction of BBB and their increased filtration from peripheral blood [360]. Therefore, CSF may be taken into consideration in the search for more specific brain tumor biomarkers [361], although obtaining CSF for testing has certain limitations from medical and legal points of view [362,363]. On the other hand, extending the diagnostic panel of tests by the possibility to determine chemokines and their receptors as the CSF biomarkers, could be helpful in a better assessment of the clinical condition of patients with brain tumors.…”

The Implication of Reticulons (RTNs) in Neurodegenerative Diseases: From Molecular Mechanisms to Potential Diagnostic and Therapeutic Approaches

“…Determination of the concentration of potential novel biomarkers in CSF requires a lumbar puncture, a procedure which has certain medical and legal limitations. Since it is more invasive than obtaining a blood sample, it requires additional consent from the patient, which is regulated differently in different countries [ 119 ]. The norms of medical law, intel alia, define the relationship between medical professionals and their patients, and regulate the performance of clinical procedures, such as the collection of cerebrospinal fluid by lumbar puncture.…”