Handbook on Ethical Issues in Aging

By Tanya Fusco Johnson | Go to book overview

8
Ethical Issues in the Care of the Judgment Impaired

Lawrence Heintz

Judgment impairment is a matter of degree and comes in many forms. The individual who has total and permanent loss of judgment possesses a very different set of problems from one whose loss is partial or intermittent. Correspondingly, the moral questions that arise when we are dealing with the patient in a persistent vegetative state, for example, are very different from those presented by the confused or disoriented patient. We will be able to consider only some of a whole spectrum of moral questions that arise in this context: To what degree is this individual able to make health care decisions? If the individual is not able, who should make decisions and on what basis? What role do advance directives play? Who should become the surrogate decision makers, and what standards should such decision makers use in forming their decisions? But first let us remind ourselves of the scope or the magnitude of the population and issues that we are dealing with.


WHO IS INCLUDED IN THE "JUDGMENT IMPAIRED"?

The magnitude of the problem begins to be grasped once one recognizes that by the year 2000, 11.5% of Americans will be over 65, and estimates vary that from 10% to 18% of them will have clinically significant cognitive impairment. Also, there are two important progressions taking place (see Tables 1 and 2) in the aging of America -- the number of elderly and the distribution of the elderly -- that, when understood, reveal the ballooning nature of this problem.

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