Respecting the wishes of people with dementia while keeping them safe

Even if their cognitive abilities diminish, people with dementia feel emotions and have a right to live with dignity.

- Philip Yap, Gabriel Wong and Iason Foo

Mr Lee is a 70-year-old ex-teacher with diabetes and mild dementia. He lived alone and was hospitalised after a giddy spell due to low blood sugar caused him to fall. It likely happened because he ate erratically and would sometimes double dose on his diabetes medication on account of memory lapses.

Although he was able to navigate his neighbourhood and manage simple finances before he was hospitalised, Mr Lee frequently felt giddy and fell often at home. His only relative was a sister who visited him once a month.

It was deemed unsafe for him to continue living by himself and that he'd be better off in a nursing home.

On hearing this, Mr Lee dug in his heels and demanded immediate discharge from the hospital. He appeared to appreciate the risks of living alone but prioritised his freedom over safety.

But when asked about his long-term plans to ensure his continued well-being, Mr Lee could not give a definitive answer. Therein lies the conundrum. If it is assessed that Mr Lee possesses adequate mental capacity to make an informed decision, should he be allowed to go home and risk further mishaps which may even threaten his life?

On the other hand, if it is determined that he lacks mental capacity, should his wishes be thwarted, and he be institutionalised against his will?

Can we seek a solution that balances respect for his wishes to live at home, and secure his safety and well-being at the same time?

Persons living with dementia face complex care and medical needs that warrant carefully considered decisions. When confronted with such decisions, these people are assessed on their mental capacity to make informed choices. Otherwise, healthcare professionals, donees or legal guardians will act in their best interests.

The problem arises when those deemed to possess mental capacity make decisions that are detrimental to themselves, while those who lack mental capacity have unwelcome decisions imposed upon them.