A person-centred approach to decision-making and care for persons living with dementia

Global population ageing will increase the prevalence of cognitive impairment and dementia. Persons living with dementia (PLWDs) often face complex care and medical needs that entail carefully considered decisions. The current framework for decision-making prioritises mental capacity, personal autonomy and best interests. PLWDs are assessed on whether they possess the mental capacity to make informed decisions and if not, healthcare professionals (HCPs) will act in their best interests. However, as decision-making capability exists in a continuum and varies depending on the complexity of the health issue, there may be subjectivity among physicians in categorising PLWDs into those with or without mental capacity, especially in borderline cases. Furthermore, such a binary and reductive approach may not secure the best outcomes if conducted in a legalistic manner. PLWDs deemed to possess mental capacity are allowed to make decisions that may be detrimental to themselves while those assessed to lack mental capacity have unwelcome decisions imposed upon them. This paper proposes a person-centred framework that promotes relational autonomy so as to enable PLWDs to express their values and preferences in a manner that serves them best. The framework is a convenient guide in helping HCPs enable PLWDs to have a better hold on to their personhood and agency, and balance the demands of upholding autonomy with best interests.