NOTHING BUT THE TRUTH? ON TRUTH AND DECEPTION IN DEMENTIA CARE

Lies and deception are often used in the care for demented elderly and often with the best intentions. However, there is a strong moral presumption against all forms of lying and deceiving. The goal of this article is to examine and evaluate concrete examples of deception and lies in dementia care, while addressing some fundamental issues in the process. It is argued that because dementia slowly diminishes the capacities one needs to distinguish between truths and falsehoods, the ability to be lied to also disappears. When the moral reasons to reject lying are explored, it becomes clear that most of them also hold where demented patients are concerned, though this also depends on the capacities of the patient. Lying, though prima facie wrong, can sometimes be justified with an appeal to well-being. The relationship between well-being and the truth is further explored. Two examples of deceiving demented patients for reasons of beneficence are discussed, from which it can be concluded that although in some cases beneficent lies or deception will not enhance patients' well-being, there are circumstances in which they do. In general, methods that enhance the well-being of the patient without deception or lies should be favored above options that use deceit, and methods of getting the truth across without hurting the patient should be favored above blunt honesty Finally it is important to note that not only the patient but also the nursing and medical staff can be affected by the use of lies and deception.     

WHAT IS IT TO BE A DAUGHTER? IDENTITIES UNDER PRESSURE IN DEMENTIA CARE

This article concentrates on the care for people who suffer from progressive dementia. Dementia has a great impact on a person’s well‐being as well as on his or her social environment. Dealing with dementia raises moral issues and challenges for participants, especially for family members. One of the moral issues in the care for people with dementia is centred on responsibilities; how do people conceive and determine their responsibilities towards one another? To investigate this issue we use the theoretical perspective of Margaret Walker. She states that ideas about identity play a crucial role in patterns of normative expectations with regard to the distribution of responsibilities in daily practices of care. The results of this study show how the identity of a family‐member is put under pressure and changes during her loved one’s illness that leads to difficulties and misunderstandings concerning the issue of responsibility. These results offer an insight into the complexities of actual practices of responsibility and highlight the importance for those caring for people with dementia of attending carefully to how they see themselves and how they see other people involved (Who am I? Who do I want to be for the other?). Answers to such questions show what people expect from themselves and from one another, and how they, at any rate, are distributing responsibilities in a given situation. Professional caregivers should take into account that family members might have different ideas about who they are and consequently about what their responsibilities are.     

LIVING TO THE BITTER END? A PERSONALIST APPROACH TO EUTHANASIA IN PERSONS WITH SEVERE DEMENTIA

The number of people suffering from dementia will rise considerably in the years to come. This will have important implications for society. People suffering from dementia have to rely on relatives and professional caregivers when their disorder progresses. Some people want to determine for themselves their moment of death, if they should become demented. They think that the decline in personality caused by severe dementia is shocking and unacceptable. In this context, some people consider euthanasia as a way to avoid total deterioration. In this article, we discuss some practical and ethical dilemmas regarding euthanasia in persons with severe dementia based on an advance euthanasia directive. We are using a personalist approach in dealing with these ethical dilemmas.     

FAT AND CARBOHYDRATE METABOLISM IN HUMANS—A Study of Nutritional and Hormonal Effects

As an index to the rate of fat utilization in human subjects, the recovery of all radioactive carbon dioxide in the expired air was measured for one hour following intravenous injection of palmitate-1-C¹⁴. In the normal fasted subject, about 10 per cent of the injected dose was recovered, and the proportion was lowered to about 5 per cent by administration of glucose. With prolonged fasting, the recovery of radioactive carbon dioxide did not change, despite a rising concentration of fatty acids in the serum. This was interpreted as due to the development of a balance between increasing mobilization and oxidation and was thought to indicate increasing fatty acid oxidation.In chronic undernutrition and diabetes mellitus there was increased fatty acid oxidation due presumably to adaptation to a chronic increase in fat utilization for energy.Administration of human growth hormone did not increase fat oxidation but prevented the usual inhibition produced by glucose. This was interpreted to mean that growth hormone increases fat utilization only indirectly by inhibiting the usual preferential utilization of glucose over fat.     

PHOSPHATE METABOLISM IN BLUE-GREEN ALGAE. II. CHANGES IN PHOSPHATE DISTRIBUTION DURING STARVATION AND THE “POLYPHOSPHATE OVERPLUS” PHENOMENON IN PLECTONEMA BORYANUM

Physiological aspects of phosphate utilization by the blue-green alga Plectonema boryanum were studied. It was found that the external phosphate concentration influenced the distribution of phosphorus-containing compounds in the cell. Culturing the alga in concentrations of 10, 100, and 1000 mg PO₄/l resulted in increases in the level of acid-soluble and acid-insoluble polyphosphates. The values reported for 100 and 1000 mg PO₄/l were the same, indicating that the cells were able to assimilate and utilize only fixed amounts of phosphates. The total phosphorus value for these cells was calculated to be 6.5 μg P per 10⁶ cells. Culturing the alga in 1 mg PO₄/l led to a decrease in phosphate concentration of all cell fractions. Cells grown in the absence of phosphate for 5 days had total cell phosphorus levels of 0.76 μg P per 10⁶ cells. Cells in culture for two months or longer were found to have total cell phosphorus levels of 0.73 μg P per 10⁶ cells. This was determined to be the minimum cell phosphorus level limiting growth. Transfer of cells from either culture condition to a medium containing phosphate led to an “overplus” phenomenon. This overplus phenomenon was characterized by increases in all cellular phosphorus fractions. The most dramatic increase was found in both the acid-soluble and acid-insoluble polyphosphates. These fractions often increased by more than an order of magnitude. The greatest phosphate uptake occurred within 1 hr of transfer of phosphate-starved cells into a medium containing a known amount of phosphate and is essentially complete at 4 hr. The total cell phosphorus levels for uptake never increased beyond 18.9 μg per 10⁶ cells.