Justice and the Severely Demented Elderly
Brock, Dan W.
Journal of Medicine and Philosophy. 1988 Feb; 13(1): 73-99.
In this paper I address the relation between just claims to health care and severe cognitive impairment from dementia. Two general approaches to justice in allocation of health care are distinguished--prudential allocation and interpersonal distribution. First, I analyze why a patient who has died has no further claims to health care. Second, I show why prudential allocators would not provide for health care treatment should they be in a persistent vegetative state. Third, I argue that the destruction of personal identity from severe dementia implies that only claims to palliative, but not life-sustaining, health care remain. Finally, I argue that the prudential allocator approach is indeterminate regarding life-sustaining care for the moderately demented and that social policy should not deny that care to patients.
Advance Directives; Age Factors; Aged; Allowing to Die; Autonomy; Brain; Brain Pathology; Cadavers; Costs and Benefits; Death; Dementia; Health; Health Care; Health Insurance; Insurance; Justice; Life; Moral Obligations; Obligations of Society; Patient Care; Patients; Persistent Vegetative State; Personhood; Prolongation of Life; Public Policy; Quality of Life; Rights; Self Concept; Speciesism; Suffering;
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