Understanding the Perspectives of Seniors on Dementia and Decision-Making.

The study suggests support among seniors for: (1) a model of "supported decision-making" rather than "surrogate decision-making;" (2) a presumption that in order to preclude a person with dementia from making more "personal" decisions a more heightened showing of incapacity is required; and (3) a shift to a model of capacity as based more on features such as long term memory and relationships rather than cognitive functions or values. In reforming our understandings of capacity, ethicists and practitioners will have to navigate tensions found in the qualitative data, including: (1) between participants' fear of abuse and their expressions of trust in family members to decide when intervention is appropriate; and (2) between expressions of confidence in medical professionals' ability to tell participants when they are no longer able to make decisions and participants' own understanding of the question in terms of the philosophical construct of personal identity.