Can Bioethics Protect the Holders of Compromised Decisional Competence?

Abstract

Background This article aims to address questions related to the protection of rights of holders of compromised decisional competence, to make decisions, especially for its condition of vulnerability in relation to the other members of the human community to which they belong to, in access to the preservation of their dignity.
 Methods and Findings Although Bioethics has been increasingly evolving in plural and secular democratic societies, gaps and conflicts deserve a special reflection which can result in new paths and solutions for those with limitations in their abilities of understanding and determine according to this understanding, making decisions that may not translate a reflected decision about the health care they can undergo, as well as participation in scientific research and other issues involving their health and their bodies.
 Conclusions This work recommends a greater appreciation of patient autonomy, as well as embracing the Advance Directive of Will in the western world, with some limitations encountered, and some suggestions offered.

Advance Directives: Knowledge of the Topic Among Psychiatrists

“…In conclusion, psychiatrists can be consulted by those complaining of memory changes, and, in cases of a diagnosis of dementia symptoms, the patients can, at least initially, be encouraged to draft advance directives so long as their cognition and awareness allow for it. This is an opportunity that should not be lost ( 2 ).…”

“…In ancient Rome, citizens could refuse medical treatment and even choose death, provided that within the culture of the time they were considered rational and able to assess the consequences of their act ( 1 ). In the current context, where death has been displaced to the hospital environment and technology can lead to disproportionate treatments, it is necessary to reflect on basic concepts ( 2 ).…”

“…It is very important to emphasize that patients' ability to understand and make decisions for themselves is fundamental to drawing up an advance directive that may actually achieve its proposed objective. Furthermore, the diagnosis of a disease that, in its presumed evolution, tends to compromise a patient's reasoned decision-making capacity should be accompanied by actions that stimulate the elaboration of an advance directive while the patient is still able ( 2 ).…”