Vegetarian for Life

4. Exploring ethical dilemmas in dementia #DementiaActionWeek

Posted by Tom on 16/05/24 in Articles, Life After Retirement

For Dementia Action Week we bring you a series of special articles concerning the treatment of older vegans and vegetarians living with dementia. Today, we hear again from Drs. Lavazza and Reichlin, and their study of a case in which the Swedish Ethics Committee opted to serve meat to Oscar, a dedicated vegan grappling with Alzheimer’s, deeming it the optimal solution.

“So this is… a very interesting new approach to the case." continues Dr. Lavazza. "Obviously, we can try to translate these philosophers'  approaches to our case… we know that meat was served to Oscar as the Swedish Ethics Committee took it to be the best solution for him, in their view. But we in our paper also consider other possible the reasons not to serve or to serve meatballs to Oscar regarding different approaches or different considerations.”

Co-author, Dr. Reichlin, agreed that a variety of factors should be considered when dealing with complex cases such as dementia. He felt that no single factor can fully determine the best course of action: “The disease is moving through several stages. And so you need a moment by moment, so to say, consideration of the relevant elements. So there is the topic of autonomy and also the topic of previous autonomy.”

“We in our paper also consider other possible the reasons not to serve or to serve meatballs to Oscar regarding different approaches or different considerations.”

Reichlin highlighted the importance of moment-to-moment assessment, touching on concepts such as autonomy, past autonomy, and well-being: “As Dworkin says, if I write down now today my directive is my autonomy. These are my critical interests, including, for example, my preferences for vegan food or vegetarian food. But this is an important element, but it is not the only one. Because Jaworska says there is some kind of autonomy which is different from this because it is much less rational or rationalistic. It is expressed in these capacities of attaching value to relationships, to people, to things, which is in the medium phases of Alzheimer's disease and dementia in general can still be expressed.

“You cannot fail to acknowledge this important element. And then there is also so-called ‘best interests’, well-being, interests. And of course, when there is nothing is left of autonomy, these considerations of well-being are also important, but the different elements have different weights at different points. This is the main message, and that's why new findings in neurology and clinical evidences are so important in order to tackle the ethical issues.

The authors’ paper stresses the significance of recognising the value of relationships, people, and personal connections in decision-making, referencing a consideration by Frankel and Blennberger: “This is the fact that, since his wife also shares a commitment to veganism, Oscar’s becoming a meat eater may generate negative reactions in her. She may start to think negatively of him, and may even refuse to meet him again. Though some may want to discount this possibility as relatively unlikely, the risk of corrupting the marital relationship should be seriously considered in an overall assessment of [Oscar]’s best interest.”

Reichlin concludes: “Preferences concerning diets are an important part of moral identity. They are a moral trait. So they must be given proper consideration – both from the perspective of the patient himself or herself. But also it is important in the eyes of other people that these other people, relatives, friends, people that you have [known] throughout your life, they associate these elements to your identity. So even if the patient[‘s] memory lapses and fails to acknowledge people… these are elements which are still important and still express his personality, and therefore it is important to take these elements into consideration.”

Central to Lavazza and Reichlin’s analysis is the consideration of a pluralism of factors, recognising the evolving nature of autonomy and the importance of factors like well-being and personal identity. The authors stress the significance of integrating new findings from neurology and clinical evidence into ethical deliberations concerning individuals with dementia.

Moreover, they highlight the ethical weight of dietary preferences as an integral part of one's moral identity, deserving careful consideration even amid cognitive decline.

Read Vegetarian for Life’s own thoughts, and how carers and concerned individuals might translate this into best practice in our final instalment.


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