Abstracts
Abstract
Behavioural variant frontotemporal dementia (bvFTD) is a subtype of frontotemporal dementia characterized by changes in personality, social behaviour, and cognition. Although neural abnormalities cause bvFTD patients to struggle with inhibiting problematic behaviour, they are generally considered fully autonomous individuals. Subsequently, bvFTD patients demonstrate understanding of right and wrong but are unable to act in accordance with moral norms. To investigate the ethical, legal, and social issues associated with bvFTD, we conducted a scoping review of academic literature with inclusion & exclusion criteria and codes derived from our prior work. Among our final sample of fifty-six articles, four mentioned bvFTD patient-offenders as unfit to stand trial by insanity, and sixteen mentioned the use of dementia evidence in a court of law to better understand the autonomy of bvFTD patients. Additional emergent issues that were discovered include: training police officers to handle situations involving bvFTD patients and educating healthcare providers on how to help caregivers navigate bvFTD. The current literature highlights the inadequacy of traditional applications of medico-legal categories such as autonomy, capacity and competence, in informing cognitive capacity assessments in clinical and legal settings and deserves consideration by neuroethicists.
Keywords:
- decision-making,
- frontotemporal dementia,
- neurodegenerative disease,
- neuroethics,
- regulatory issues
Résumé
La variante comportementale de la démence frontotemporale (vcDFT) est un sous-type de démence frontotemporale caractérisé par des changements de la personnalité, du comportement social et de la cognition. Bien que les anomalies neurales fassent que les patients atteints de vcDFT aient du mal à inhiber les comportements problématiques, ils sont généralement considérés comme des individus totalement autonomes. Par la suite, les patients atteints de vcDFT démontrent une compréhension du bien et du mal, mais sont incapables d’agir conformément aux normes morales. Afin d’étudier les questions éthiques, juridiques et sociales associées au vcDFT, nous avons procédé à une revue de la littérature académique avec des critères d’inclusion et d’exclusion et des codes dérivés de nos travaux antérieurs. Parmi notre échantillon final de cinquante-six articles, quatre mentionnent les patients atteints de vcDFT comme inaptes à être jugés pour cause de folie, et seize mentionnent l’utilisation de preuves de démence dans un tribunal pour mieux comprendre l’autonomie des patients atteints de vcDFT. D’autres questions émergentes ont été découvertes, notamment la formation des policiers aux situations impliquant des patients atteints de vcDFT et l’éducation des prestataires de soins de santé sur la manière d’aider les soignants à faire face à la vcDFT. La littérature actuelle met en évidence l’inadéquation des applications traditionnelles des catégories médico-légales telles que l’autonomie, la capacité et la compétence, pour informer les évaluations de la capacité cognitive dans les contextes cliniques et juridiques, et mérite d’être prise en compte par les neuroéthiciens.
Mots-clés :
- prise de décision,
- démence frontotemporale,
- maladie neurodégénérative,
- neuroéthique,
- questions réglementaires
Appendices
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