Vem ska besluta om äldres vård? - Om självbestämmande och vårdbehov för äldre med kognitiva funktionsnedsättningar
Sammanfattning: As the number of elderly people in the population grows, the number of elderly people who suffer from cognitive disabilities (different forms of dementia) who require care grows as well. The purpose of the thesis is to examine the relationship between elderly people’s autonomy and their need of care. Care cannot be given without consent from the individual unless there are exceptions stated in the law. A valid consent requires that the individual understands the meaning and the consequences of the consent. Elderly people with cognitive disabilities can, due to their sickness, have a reduced ability to provide a valid consent. Care without consent can be given if there is an emergency. Social adequacy can also provide some possibilities to give care without consent. However, to what extent social adequacy can be used is not entirely clear. According to international agreements those who cannot decide for themselves should receive the help they need to make decisions. No one else should be allowed to make their decisions. In Sweden, however, deputy representation is arranged so that the deputy makes decisions for the individual, rather than giving the individual the necessary help to be able to make decisions for themselves. A deputy can help the elderly person with personal affairs but cannot make decisions about the person’s care. If the person refuses care, a deputy cannot consent to the person’s care. It is not clear who will decide on the care of these people when they do not have the ability to decide for themselves. Due to lack of regulation, the decision of the deputy (or next of kin) seems to be accepted regarding the care of the elderly person. An important aspect of deciding on the care of the elderly with cognitive disabilities is establishing what should guide the decision-making. It is possible that the decisions should be guided by the best interests of the person or according to what the person hypothetically would have wanted if he or she had insight into his or her state of disease (hypothetical will). The decisions could also be guided by the person's previously expressed will or according to the person’s present will. There are problems with every option. Letting the decisions be guided by the person’s best interests omits the elderly person to someone else's interpretation of what is best. Letting the decisions be guided by hypothetical will and previously expressed will is problematic because it does not recognise who the elderly person is today and is based on someone else’s image of who the elderly person was. It is also questionable if the elderly person’s autonomy is strengthened by a hypothetical person’s will. Finally, an elderly person’s well-being is at risk if the decisions are based solely on the will they express when they suffer from cognitive disabilities.
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