Ethical issues and decision making in the terminal stage of Alzheimer's disease

The decisions to be taken regarding people with terminal stage dementia condition (Alzheimer disease and related disorders) are often subject to strong ethical questioning. The stakes involve the patient himself and the society. The difficulty of decision-making lies in one hand in the specific vulnerabilities of these patients, and in the other hand in the circumstances of their end of life. In this context, the ethical approach requires first of all to respect each case's uniqueness. This practice then takes place in a frame represented by legislative, deontological and ethical criteria. The question deals with the respect of psychically and cognitively vulnerable subjects. The ethical decision should, as far as possible, make provision for protecting the respect of the four fundamental ethical principles: non-malevolence, beneficence, autonomy, justice. Finally, taking benefit from philosophy can help in the decision process. For instance, thoughts from Emmanuel Levinas enriches the understanding of the ethical foundations of medical decision-making within the clinical relation. Respecting the ethical decision process may allow reaching the most favourable choice for the end of life of dementia condition patient. (C) Elsevier Masson SAS. All rights reserved.