Law and Ethics
Age and Ageing
Introduction Decisions regarding end-of-life treatment for patients with dementia (PWD) remain contentious. While previous research in this context has predominantly been conducted within a quantitative framework, little is known about the reasons underlying health professionals' beliefs; not least the ethical/philosophical concepts which may complicate decision-making in this patient group. Methods Semi-structured interviews were conducted with 6 participants (comprising: Medicine for the
... ly [MFE] Consultants, Psychogeriatricians, and MFE Specialist/Psychiatric Liaison Nurses) working within the Norfolk and Norwich University Hospital NHS Trust. The interviews employed open-questions relating to: competence, autonomy and selfhood, quality of life, and the role of health professionals and relatives in decision-making. Audiotapes of the interviews were transcribed and responses coded by hand using interpretative content analysis. Results Dominant themes among participants' responses related to the difficulties posed by assessing quality of life and defining 'best interests' in PWD, and the role of relatives in end-of-life treatment decisions (EOLTDs). Conclusions The ethical and philosophical debates concerning dementia are real issues influencing EOLTDs in clinical practice. In particular, this research highlights the increasing role relatives play in influencing EOLTDs, underscoring the benefits and disadvantages associated with incorporating the 'family perspective'. There is a need for open and early dialogue regarding end-of-life issues, as well as greater training for health professionals with regard to this difficult task of communication if optimal end-of-life care for PWD is to be achieved.