Cognition & Consent

If you were diagnosed with Dementia or Alzheimer’s there’s a word that would start to pop up: continence. Which refers to someone’s compacity to think for themselves, from urination to sex. The lack of cognition in an individual somewhat defines their state of mind with a lack of restraint, usually through some sort of assessment proving that they are no longer able to make decisions for themselves. When diagnosed, a level of consent is taken from that individual and placed in the hands of their POA, usually their child, a family member, or in some cases a social worker. Although every individual experience is different, this change in rights can still be grating to those who experience it.

When an individual with memory loss is assessed and diagnosed, that’s around the same time their POA would be assigned and custody given. To gain custody and become someone’s power of attorney, or POA, there are a few things you need to prove. First, there must be proof that their new POA will act in that person’s best interest, use the least restrictive option with them, and exhibit proof that the said person is unwise in making their own decisions. If all points are met and the assessment seems lawful, only then will custody be granted. These key principles are applied from the Mental Capacity Act developed in 2005 that clarifies the legal position of those providing help or services to people who may lack the capacity to take certain actions or decisions for themselves. 

When it comes to memory loss’s version of freedom, it’s not easy to define what that definition is. Freedom is a very broad blanket term to show free will. Yes, there are a dozen different kinds of living situations offered to those with declining continence, but said places aren’t always ideal. Most common placements for these individuals are memory care facilities or simply a retirement home. These kinds of placements aren’t always one the individual has a choice in. On occasion, while checking into these facilities residents have been extremely misled. There have been instances where POAs fear their dependents’ reaction to moving, and instead of explaining the situation, can legally trick them into this residential change. 

This has happened enough to the point where it’s become an alternative method to moving someone. To all together walk into a facility, their POAs/family leave, while the individual stays in a locked area. Only to later find out they are permanently living there, usually forgetting the events as time goes on. Almost every case of this happening has the new resident reacting to the change, understandably upset and/or exit seeking. Many new admissions have been reported to forget that this new place is their home, which is understandable after such an unorthodox moving process. This can lead individuals to relive the fear of never seeing their ‘real home’ again and again. As far as making decisions for someone, this specific method seems relatively cruel to adapt to, anything but in that person’s best interest.

As incontinence turns to decline, one must consider the lack of consent given to someone who struggles to communicate. When comfort medications are ordered to those with declining cognition, hourly morphine is not only given if the resident says ‘yes or no’ it’s decided by the medical professionals around them who see it fit. End of life care is admirable to say the least, at it’s core there are caregivers, home health aids, and hospice nurses who stop at nothing to provide needed care to those who can’t care for themselves.

That being said, going onto hospice is rarely seen as a glamorous alternative way to die. Although it is a better alternative to the all natural way, comfort measures can still be an enormous adjustment physically and emotionally. From Lorazepam to Morphine, comfort care medications are usually administered to reduce pain and encourage a patient’s persistence towards death. That process can take as much or little time as it needs to, from days, weeks, months someone can teeter totter between life and a downhill decline.

With all things considered, it’s already hard enough for individuals with declining cognition to have to rely on others to perform everyday tasks. When alternative methods of care resort to lack of consent when relocating then that’s when that individuals quality of life is truly thrown out the window. From caregivers to administrators, memory care facilities strive to provide long term environments with their residents best interest in mind. Although the intention was adequate, the implementation has shittier results then their patients brief’s.

Source: Getty Images

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