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PubMed1998

Competency and consent in dementia.

Health care for demented older persons presents a range of ethical dilemmas. The disease process affects cognitive abilities, making competency a central issue. The syndrome of dementia carries a complex social overlay that colors perceptions of these patients and of their capacity for making decisions. An argument is made for a coherent, ethically based decision-making process that can be applied across the whole spectrum of dementia severity. The major ethical principles implicated in assessing a patient's ability to consent to treatment are reviewed. A sliding scale model of capacity is presented, in which the patient's ability to decide is weighed against the risk associated with the treatment decision in question. This model preserves the autonomy of the demented patient while minimizing the potential for harm. In situations where the patient is deemed incapable, two approaches that can be applied to making treatment decisions are contrasted. The 'prior competent choice' standard stresses the values that the patient held while competent. The 'best interests' standard moves the focus to the patient's subjective experience at the time the treatment is considered. The relative merits of these two concepts are evaluated in the context of dementia. Surveys of actual decision-making practice are contrasted with ethical and legal principles. The challenges inherent to applying the best interests standard are discussed. Despite the pitfalls, this standard offers an opportunity to restore the demented patient's sense of self.

Advance Directives↗
PubMed1997

Prevalence of congenital colour blindness among Inuit in East Greenland.

PURPOSE: To establish whether congenital colour blindness among males is still rare in Inuit (Eskimos) as indicated previously in 1893 and 1930, especially in East Greenland, as demonstrated by Erik Skeller in 1950. METHODS: The study was comprised mainly of school children. 540 Inuit in East Greenland were compared to 545 controls in East Greenland and Denmark examined by three sets of pseudoisochromatic plates (Ishihara 1932, original plate used by Skeller), Ishihara (1994), and standard P.P. 2 part Igaku-Shoin (1994). RESULTS: Only 1.0% of male Inuit (3/290) are colour blind, a significantly lower incidence than the 8.7% among Danish males in Denmark (15/173). The prevalence was the same in the three control groups, Danes in East Greenland, immigrants and Danes in Denmark. Deuteranopia is the most common type. Females showed the same low prevalence in all four groups. MAJOR CONCLUSIONS: Colour blindness is still remarkably low among Inuit in East Greenland as compared with the present three control groups.

Adolescent↗
PubMed1998

Blue-yellow perimetry in patients with ocular hypertone.

The authors report the data of the blue-yellow (B-Y) perimetry compared with the Standard perimetry in normal subjects with endocular hypertension or with initial glaucoma. With the aim of evaluating the relationship with chromatic sense deficits, precociously found in glaucoma, the F-M 100 Hue test and Lanthony D 15 Desaturé test were done. Checks were made of refraction, visual acuity, pupil diameter and assumption of medications. Sensitivity reduction in eyes with initial glaucoma is highly significant with the B-Y perimetry. Pupil diameter reduction is quite uninfluential while the chromatic sense shows some quantitative and qualitative deficits.

Adult↗