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Dying in a Homophobic Nation: Addressing Healthcare Disparities, Advance Care Planning and Surrogate Decision-Making Challenges for Sexual and Gender Minority Older Adults at End-of-Life.
Am J Hosp Palliat Care
January 2025
NYU Langone Health, New York, NY, USA.
Promoting autonomy in medical decision-making is an essential part of palliative care. Therefore, palliative care providers should prioritize supporting the autonomy of sexual and gender minority (SGM) older adults, a community that has historically suffered from healthcare disparities. This support is particularly significant when an illness or injury renders a patient unable to make medical decisions, necessitating the designation of a surrogate decision-maker.
View Article and Find Full Text PDFSeeking consensus on dilemmas related to euthanasia in dementia based on an advance directive: a Delphi study from a medical, ethical and legal perspective.
J Med Ethics
January 2025
Medicine for Older People, AmsterdamUMC Location VUmc, Amsterdam, The Netherlands.
Euthanasia in dementia based on advance euthanasia directives (AEDs) is possible within the Dutch Euthanasia law. Yet, physicians struggle with the responsibility of interpreting the law's open norms in cases of advanced dementia, which includes the fulfilment of the due care criteria. This Delphi study aims to analyse arguments and seek consensus from medical, ethical and legal perspectives on ethical dilemmas in such cases.
View Article and Find Full Text PDFNavigating Dementia and Delirium: Balancing Identity and Interests in Advance Directives.
Nurs Philos
January 2025
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
The moral authority of advance directives (ADs) in the context of persons living with dementia (PLWD) has sparked a multifaceted debate, encompassing concerns such as authenticity and the appropriate involvement of caregivers. Dresser critiques ADs based on Parfit's account of numeric personal identity, using the often-discussed case of a PLWD called Margo. She claims that dementia leads to a new manifestation of Margo emerging, which then contracts pneumonia.
View Article and Find Full Text PDFDespite mandates requiring hospitals to offer advance directives to all patients, many adults do not have advance directives in place at the end of life. This quality improvement project aimed to implement an evidence-based, standardized protocol to increase advance directive completion rates for hospitalized patients with serious illnesses. A preimplementation and postimplementation design was used to evaluate the impact of an educational intervention and advance directive completion protocol.
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