Justice and the severely demented elderly.
In this paper I address the relation between just claims to health care and severe cognitive impairment from dementia. Two general approaches to justice in allocation of health care are distinguished--prudential allocation and interpersonal distribution. First, I analyze why a patient who has died has no further claims to health care. Second, I show why prudential allocators would not provide for health care treatment should they be in a persistent vegetative state. Third, I argue that the destruction of personal identity from severe dementia implies that only claims to palliative, but not life-sustaining, health care remain. Finally, I argue that the prudential allocator approach is indeterminate regarding life-sustaining care for the moderately demented and that social policy should not deny that care to patients.
Brock
D W
DW
Department of Philosophy, Brown University, Providence, RI 02912.
D000368:Aged; D001927:Brain Diseases; D003704:Dementia / Q000628:therapy*; D004992:Ethics, Medical; D006291:Health Policy / Q000331:legislation & jurisprudence; D006299:Health Services for the Aged / Q000331:legislation & jurisprudence*; D006801:Humans; D008020:Life Support Care / Q000331:legislation & jurisprudence; D028681:Moral Obligations; D010344:Patient Advocacy / Q000331:legislation & jurisprudence*; D026684:Personal Autonomy; D028723:Personhood; D040841:Resource Allocation; D012935:Social Justice; D013315:Stress, Psychological; D014481:United States; D028761:Withholding Treatment