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Commentary on Part V: A Clinician’s Commentary from a Post-Soviet Society on Organizational Issues of Care for Alzheimer Disease
- Johns Hopkins University Press
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m Commentary on Part V A Clinician’s Commentary from a Post-Soviet Society on Organizational Issues of Care for Alzheimer Disease Givi Javashvili, M.D., Ph.D. In this part of the book (part V), my collaborators have addressed organizational issues of care for persons with Alzheimer disease (AD) raising ethical aspects of care. They emphasize correctly that the goal is to actually change the lives of people with AD. But for these changes to occur, a variety of organizational issues must be given attention, including development of an appropriate legal framework, adaptation of public health policy, elaboration of professional standards, revision of training curricula for doctors and nurses, and implementation of a system of quality control, to name some. Writing as the only other contributor to this volume who represents Central and East European (CEE) countries, I want to draw attention to the contribution by Eugenius Gefenas. I will also comment briefly on others. Gefenas (chapter 17) emphasizes social,cultural,and other differences between CEE countries and the rest of Europe (developed European states) and shows how these differences eventually led to the formation of different legal frameworks for dealing with the problem of autonomy of incapacitated persons (including persons with AD). These differences are highlighted in today’s era of integration when the legal frameworks of member states of the Council of Europe (COE) must be made compatible with the binding legal texts (i.e., conventions or recommendations) of the COE. He explores existing distinctions between legal systems in relation to the protection of incapacitated persons (the traditional type of system versus an alternative type of system) and comments on existing realities in CEE countries , attributing the delay in introducing an alternative system to cultural and ideological peculiarities of the CEE countries. Certainly, the ideology of totalitarian states in Central and Eastern Europe supported the sacrifice of individualism and personal autonomy for the “best interest of the society,” and these states very often succeeded in implementing that ideology in practice. This was true in the health care setting as well, and health care professionals usually did not acknowledge the principle of patient autonomy. However, it is inaccurate to say that the culture of the entire CEE society was geared to disregard completely the principle of personal independence during the years of the authoritarian regime, particularly in those states that became part of the Communist group only after World War II. It is worth noting that the ideology and resulting legislation in the latter countries did not necessarily fully reflect the culture and true attitudes of the larger society. This assumption may be supported by Gefenas’s observation about Lithuania that “very few adults with AD and other dementias have this kind of protective measure. The most usual motive in applications for guardianship is an attempt by family members to take care of the property of the person concerned.” The cultural specificity of different populations in the posttotalitarian era has deep roots and warrants further research and analyses. Another notable subject dealt with in Gefenas’s chapter is the different meanings of autonomy in the context of care for incompetent persons and the tendencies in CEE countries to implement a libertarian concept of personal autonomy. Certainly, modern democratic societies should avoid establishing an oversimplified concept of informed consent, which sometimes becomes the only legal prerequisite for medical interventions and may be used by health care professionals mostly to protect themselves from liability.This is particularly relevant when it comes to decision making about the care of incompetent persons, including those with AD. A strict, rigid model of informed consent may leave unacknowledged real values of the person. However, I absolutely agree with the author in saying that legalizing and implementing informed consent in CEE countries is a very important movement toward enforcing the role of patients, particularly in areas where there is a high risk of abuse (e.g., biomedical research, human organ transplantation). Legalization of autonomy understood as authenticity may be the next step for these countries. Such legalization would be 306 Organizational Ethics Issues [44.220.245.254] Project MUSE (2024-03-19 12:15 GMT) very difficult to introduce in a top-down manner. It must come from the public’s belief that it is in their best interest that individual autonomy be legalized. Also of interest in Gefenas’s chapter is his characterization of CEE health care systems as libertarian, resembling the...