PROTECTING THE RIGHTS OF THE CLIENT WITH ALZHEIMER'S DISEASE
Deirdre G. Gavin
In our concern for the safety and physical well-being of a person with Senile Dementia of the Alzheimer's type (SDAT), it is easy to overlook the rights of the patient to self-determination. Protecting the rights of people with Alzheimer's disease requires care and planning so that patients' wishes may be honored when they can no longer make these wishes known.
Three topics relating to patient rights have particular relevance to the person with mental retardation who has Alzheimer's disease: competence, informed consent, and research. Addressing each of these subjects early in the disease and planning for future developments will assist the patient in making many decisions for herself and will also offer protection from exploitation.
The whole issue of competence and what it means has been repeatedly debated, and different experts use very different tests to arrive at a judgment. (See Chapter 23) In the case of Alzheimer's disease, "the notions of limited competence and intermittent competence are useful, because they require a statement of the precise decisions a person can make, while avoiding the false dichotomy of 'either competent or incompetent.' Use of these notions preserves maximum autonomy, justifying intervention only in those instances where a person clearly is of questionable competence." 1
In evaluating the competence of the person with mental retardation who has Alzheimer's, special consideration must be given to possible limitations in life experience that might falsely suggest incom-