March 5, 2015 -- William Winslade, distinguished visiting professor of law at the University of Houston Law Center, recently told a University gathering it’s vital that people make their preferences about end-of-life issues known in a legally binding way before the onset of late-stage dementia.
Winslade, who teaches, lectures, and writes about legal aspects of bioethics and mental health, spoke on “Dementia: Legal, Ethical and Psychological Issues” Feb. 26 as part of the Blaffer Art Museum’s “Innovation Series.” The lectures and programs relate to the exhibition “Janet Biggs: Echo of the Unknown,” which explores the role of memory in the construction of identity.
Winslade, who is also associate director of the UH Law Center’s graduate programs, has practiced both as a lawyer and a psychoanalyst, among other achievements. His book “Confronting Traumatic Brain Injury: Devastation, Hope and Healing,” was nominated by Yale University for a Pulitzer Prize.
Winslade said that in the 1980s, when Alzheimer’s disease was beginning to be more frequently diagnosed, it was often misdiagnosed – many patients actually had severe forms of depression. And there are many other forms of dementia with different causes than those of Alzheimer’s, he noted.
In order to get a valid diagnosis of Alzheimer’s disease, Winslade said, doctors must perform a series of tests, possibly including brain scans, and talk to family members or other caregivers.
“Even then, one of the problems with making the diagnosis is that people don’t want to hear it. Because Alzheimer’s frightens everybody, both the patients and family members, because of the uncertainties,” he said.
“Once the diagnosis is made, the problem is who takes care of somebody that has dementia?” he asked, adding that Alzheimer’s is not a form that at present lends itself to treatment, other than palliative care.
“For doctors, the problem is if you can’t cure, what can you do? You have to provide comfort, and provide support. But doctors don’t routinely spend 24 hours a day with their patients,” he said.
Winslade recommended that everyone, before any diagnosis is made, should make their preferences for medical care in the event of a terminal or irreversible condition known in advance, and put them in a legally valid form through an advanced directive.
Winslade discussed two forms– a directive to physicians, which tells doctors and hospitals what the patient prefers, and a medical power of attorney for healthcare, in which a family member or other person is empowered to speak on the patient’s behalf. Winslade said the latter is the more preferable of the two, but both are valid.
But as long as patients are confronting Alzheimer’s disease or other forms of dementia, Winslade said, it is vital that healthcare professionals and caregivers work to make their lives as meaningful as possible. That can be achieved through providing opportunities for recreation and creativity, he said.