title: The implausibility of response shifts in dementia patients.
abstract: Dementia patients may express wishes that do not conform to or contradict earlier expressed preferences. Our understanding of the difference between their prior preferences and current wishes has important consequences for the way we deal with advance directives. Some bioethicists and gerontologists have argued that dementia patients change because they undergo a 'response shift'. In this paper we question this assumption. We will show that proponents of the response shift use the term imprecisely and that response shift is not the right model to explain what happens to dementia patients. We propose a different explanation for the changed wishes of dementia patients and conclude that advance directives of dementia patients cannot be simply put aside.
authors.affiliation: Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands Medical Ethics and History of Medicine, University Medical Center Georg-August University, Göttingen, Germany.
authors.forename: Karin Rolanda
authors.initials: KR
authors.lastname: Jongsma
authors.affiliation: Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Mirjam A G
authors.initials: MA
authors.lastname: Sprangers
authors.affiliation: Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: van de Vathorst
mesh_terms: D024362:Advance Directive Adherence / Q000941:ethics*; D016223:Advance Directives / Q000941:ethics / Q000523:psychology; D003657:Decision Making; D003704:Dementia / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D016743:Mental Competency / Q000523:psychology*; D026684:Personal Autonomy; D028723:Personhood; D011788:Quality of Life; D012941:Social Responsibility
keywords: Clinical Ethics; Decision-making; Dementia; Living Wills/Advance Directives; Quality/Value of Life/Personhood