Healthcare decisions and mental capacity

Reading: Advance Medical Decision-Making Differs Across First- and Third-Person Perspectives, Toomey et al. (2024), AJOB Empirical Bioethics (via the British Psychological Society research digest).

This study asked almost 1500 people if they would honour the current healthcare wishes of someone with cognitive decline (at “time 2”) over the wishes they made before the decline (at “time 1”).

Advance healthcare decision-making presumes that a prior treatment preference expressed with sufficient mental capacity (“T1 preference”) should trump a contrary preference expressed after significant cognitive decline (“T2 preference”).

It’s a sophisticated study, with variations such as if the preference is to treat or withhold treatment.

The general pattern, though, for us “ordinary people”:

• For others, we prefer the latest (T2) preferences.

• However, for ourselves, the preference is to honour the pre-mental-decline wishes (T1).

The study ran as hypothetical stories, with T2 described as:

The character’s cognitive decline is described as substantial but not complete—they have lost many memories, generally do not recognize family members, struggle to retain new information and do not remember what they watch on TV or what is happening in the news.

It’s tricky, right? “[…] if the participant thought the T2 character was still their true self, then they were more likely to defer to their expressed [T2] preferences”.

The finding […] may have implications for surrogate medical decision-making.