The German S2k guideline: Informed consent of people with dementia to medical treatment

Abstract

AbstractDue to demographic change, the medical care system will be confronted with a growing number of people with dementia (PwD). PwD are usually multimorbid, frequently suffer from other diseases in addition to dementia and are therefore regularly confronted with decisions on medical diagnostics, treatment, or palliative care measures. Since the ability of PwD to give informed consent is often called into question, representative decisions are frequently made. In many cases, PwD are even categorically judged incapable to consent based on their diagnosis. This deprives them of their right to autonomous decisionmaking which is, however, not in line with the demands oft the United Nations Convention on the Rights of Persons with Disabilities/UN‐CRPD. To make sure that legally effective informed consent has been given, the ability to consent must be assessed. Furthermore, PwD have to receive adequate information, and they have to be adequately supported by the application of suitable measures (e.g. enhanced consent procedures). Aim of the German S2k‐ guideline “Informed Consent of people with dementia to medical measures” is to provide assistance for medical professionals with respect to the above mentioned challenges, whereby S2k defines a standard of higher quality guidelines which use formalized methodological techniques for the consensus process. The guideline was developed under the auspice of the Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN), the Deutsche Gesellschaft für Neurologie (DGN) and the Arbeitsgemeinschaft Wissenschaftlicher Medizinischer Fachgesellschaften (AWMF) in Germany. Two of the authors (JP and JH) served as chairpersons for the guideline development. The guideline contains 33 recommendations and 31 legal requirements that were consented by 24 participating medical societies and institutions, including legal and bioehtical expertise. The patient perspective was provided by the German Alzheimers Associtaion (Deutsche Alzheimer Gesellschaft). The guideline is intended to provide a structured approach to ensure that people with dementia are able to act in terms of self‐determination when making decisions about medical measures. Structure and content oft the guideline that may serve as a template for the development of similar guidelines in other countries are presented at the congress.