How should informed consent and surrogate decision-making be handled for residents with dementia?

How should informed consent and surrogate decision-making be handled for residents with dementia?

• A. Assess capacity, obtain consent if capable, involve surrogates as needed, and ensure decisions reflect resident preferences.
• B. Never involve surrogates in decisions about care.
• C. Always obtain surrogate consent regardless of the resident's capacity.
• D. Deny care when the resident has dementia.

Answer: (A)

Understanding informed consent for residents with dementia starts with recognizing that capacity can vary from decision to decision and over time. For each medical decision, determine whether the resident can understand the information, appreciate the consequences, reason about options, and communicate a choice. If they are capable, obtain consent directly and honor their preferences. If they lack capacity for a given decision, involve a surrogate decision-maker who can apply what the resident would have wanted (substituted judgment) or, if those wishes aren’t known, decide in the resident’s best interests, aiming to balance benefits and burdens. Advance directives and any previously expressed wishes should guide the surrogate’s choices. The resident’s autonomy is respected as much as possible, and surrogate involvement is appropriate when capacity is absent. Denying care outright or defaulting to a surrogate regardless of capacity undermines person-centered care.

Understanding informed consent for residents with dementia starts with recognizing that capacity can vary from decision to decision and over time. For each medical decision, determine whether the resident can understand the information, appreciate the consequences, reason about options, and communicate a choice. If they are capable, obtain consent directly and honor their preferences. If they lack capacity for a given decision, involve a surrogate decision-maker who can apply what the resident would have wanted (substituted judgment) or, if those wishes aren’t known, decide in the resident’s best interests, aiming to balance benefits and burdens. Advance directives and any previously expressed wishes should guide the surrogate’s choices. The resident’s autonomy is respected as much as possible, and surrogate involvement is appropriate when capacity is absent. Denying care outright or defaulting to a surrogate regardless of capacity undermines person-centered care.