Distinct attitudes of professionals from different medical specialties toward autonomy and legal instruments in the assessment of patients with Alzheimer's disease

Atitudes distintas de profissionais de diferentes especialidades médicas relacionadas à autonomia e aspectos jurídicos no cuidado de pacientes com demência

Abstract

The evaluation of competence of Alzheimer's disease (AD) patients to assume personal or collective responsibilities and the resulting legal implications is a relevant issue.

Objectives:

The aim of this study was to evaluate the attitudes of different medical specialists towards the disability of patients with Alzheimer's disease and practitioners' competence to interfere with decision-making autonomy.

Methods:

Professionals from different areas (Neurology, Psychiatry, Geriatrics, and General Practice) were interviewed by one of the authors, after being presented a fictitious clinical case which raised several topics, namely: [1] Critical judgment and capacity of the patient to take decisions related to daily activities; [2] The role of family physicians in nominating trustees and caregivers.

Results:

Answers to the first question did not differ regarding degree of preservation of awareness but at least 25% stressed that the patient must be carefully listened to, independent of caregiver or legal representative opinion. There were significant knowledge gaps in responses to the second question. Half of the physicians interviewed did not have adequate information about the legal aspects of caring for patients with Alzheimer's disease.

Conclusions:

Legal aspects is a topic that must be incorporated into professional training in order to improve attitudes toward the long-term management of patients with dementia.

Key words:
Alzheimer's disease; attitudes; ethical and legal aspects.

Resumo

A avaliação da competência de pacientes com doença de Alzheimer (DA) para assumir responsabilidades pessoais ou coletivas e as implicações legais resultantes constituem um tema relevante.

Objetivos:

O objetivo do estudo foi analisar as diferentes atitudes de profissionais de diferentes áreas de formação frente à incapacidade de pacientes com doença de Alzheimer e sua competência para interferir com autonomia para tomada de decisões.

Métodos:

Profissionais das diferentes áreas de atuação (Neurologia, Psiquiatria e Geriatria e Medicina geral) foram entrevistados por um dos autores, depois de serem apresentados a um caso clínico fictício, no qual alguns tópicos foram levantados: [1] Juízo crítico e capacidade do paciente para tomar decisões relacionadas ao seu cotidiano; [2] Papel do médico na escolha e nomeação de cuidadores e tutores.

Resultados:

A resposta a primeira questão não evidenciou grandes divergências quando ao grau de incapacidade, mas 25% dos entrevistados chamaram atenção para o fato de que os pacientes devem ser ouvidos e avaliados, independentemente da opinião externada pelos cuidadores e representantes legais. Na resposta ao segundo quesito ficou evidente a falta de informações sobre aspectos legais e éticos relacionados aos tutores e cuidadores.

Conclusões:

Aspectos legais constituem um tópico que deve ser incorporado ao treinamento profissional para aprimorar condutas no tratamento de longo prazo de pacientes com demência.

Palavras-chave:
doença de Alzheimer; atitudes; aspectos éticos e legais.

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Publication Dates

• Publication in this collection
  Apr-Jun 2010

History

• Received
  03 Aug 2009
• Accepted
  25 Apr 2010