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date: 19 March 2019

Abstract and Keywords

Ethical issues in older patients often arise in the context of physical and mental frailty. Professionals should be alert to the possibility that, on the grounds of frailty, the older patient’s personhood is undermined. It can often seem as if physical or mental dependence makes this inevitable and stigma results. But there are ways in which the person’s autonomy can be enhanced by those who provide care. Advance care planning is intended to preserve the person’s autonomy, but may not do so if care practices are poor. When it comes to consent, the issue of capacity is crucial. But evaluative judgements are required in assessments of capacity, as indeed they are when it comes to diagnoses of dementia or even of mild cognitive impairment. What we really need are broad judgements of best interests, which should be predicated on broad conceptions of the person as a situated embodied agent.

Keywords: Advance care planning (ACP), best interests, capacity, dementia, dependence, frailty, mild cognitive impairment (MCI), personhood, stigma

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