Law Commons^™

Grandma Got Arrested: Police, Excessive Force, And People With Dementia, Rashmi Goel

Sturm College of Law: Faculty Scholarship

Recent events have shone a light on the particular vulnerability of people with dementia to police violence. Police are arresting people with dementia and using excessive force to do it—drawing their firearms, deploying tasers, and breaking bones.

To date, little attention has been paid to the burgeoning number of people with dementia, one of society’s most vulnerable populations, and their experiences with the criminal justice system. This Article examines how dementia leads people to engage in activity that appears criminal (shoplifting (forgetting to pay), and trespass (wandering), for instance) and the disproportionate response of police. In several cases where people …

Supported Decision-Making And Merciful Health Care Access: Respecting Autonomy At End Of Life For Individuals With Cognitive Disabilities, Brenna M. Rosen

Washington and Lee Law Review

Supported decision-making is a relatively new, powerful, and quickly developing alternative to restrictive guardianships and other draconian surrogate decision-making arrangements for individuals with cognitive disabilities. Its power lies specifically in the protection and affirmation of their autonomy, allowing these individuals to remain central in the planning of their lives and affairs. Despite supported decision-making’s theoretical promise, it is often unclear whether and how the model interacts with other legislation presiding over how one may make crucial life choices, such as those at end of life.

This Note attempts to bridge the gap by analyzing how supported decision-making may be a …

Comment: The Project Of Freedom, Alexandra L. Klein

Washington and Lee Law Review

A person’s status may change over time and people should have the right to maximize their autonomy and learn and grow from their experiences. Legal structures must encourage autonomy and growth, rather than producing a static environment that prevents people from challenging external controls imposed upon their lives. Law can create legal structures that sustain an individual’s right to live according to their values. As Ms. Rosen writes, “[i]f an individual is capable of valuing, the wishes stemming from those values should dictate how the individual ought to be treated.” By protecting those values, Ms. Rosen’s Note advises us how …

Comment: Further Consideration On The Relationship Between The Americans With Disabilities Act, Supported Decision-Making, And Medical Aid In Dying, Amitai Heller

Washington and Lee Law Review

As Ms. Rosen’s Note explains in further detail, the use of supported decision-making creates an opportunity for persons with cognitive impairments to participate more fully in their end-of-life care. While this Comment focuses on the legal requirement for healthcare providers to serve people with cognitive impairments at the end of life, the tenets of patient autonomy, self-determination, and the dignity of risk must be integrated into end-of-life practice to provide guidance where legal requirements are absent or ambiguous. The use of the supported decision-making model in end-of-life care will only succeed when healthcare providers participate in an open-minded manner. It …

Cognitive Decline And The Workplace, Sharona Hoffman

Faculty Publications

Cognitive decline will increasingly become a workplace concern because of three intersecting trends. First, the American population is aging. In 2019, 16.5 percent of the population, or fifty-four million people, were age 65 and over, and the number is expected to increase to seventy-eight million by 2025. Dementia is not uncommon among older adults, and by the age of eighty-five, between twenty-five and fifty percent of individuals suffer from this condition. Second, individuals are postponing retirement and prolonging their working lives. For example, about a quarter of physicians are over sixty-five, as are fifteen percent of attorneys. The average age …

How To End Our Stories: A Study Of The Perspectives Of Seniors On Dementia And Decision-Making, James Toomey

Elisabeth Haub School of Law Faculty Publications

Because dementia can cause individuals to make decisions that they otherwise would not, the law needs a mechanism to determine which decisions are entitled to the respect of the legal system and which may be overridden by others. In the philosophical literature, three primary theories for how to make this determination have been offered. First, "Cognitivism" posits that whether a decision should be recognized is a function of the mechanical functioning of the individual's brain at the time the decision is made. Second, "Essentialism" holds that decisions should be recognized so long as they are consistent with the cluster of …

"As Long As I'M Me": From Personhood To Personal Identity In Dementia And Decision-Making, James Toomey

Elisabeth Haub School of Law Faculty Publications

As people, especially older people, begin to develop dementia, we confront ethical questions about when and how to intervene in their increasingly compromised decision-making. The prevailing approach in philosophically-inclined bioethics to tackling this challenge has been to develop theories of “decision-making capacity” based on the same characteristics that entitle the decisions of moral persons to respect in general. This Article argues that this way of thinking about the problem has missed the point. Because the disposition of property is an identity-dependent right, what matters in dementia and decision-making is an individual’s personal identity with their prior self, not their moral …

Avoiding Prolonged Dementia, Norman L. Cantor

Norman Cantor

Addressing The Ethical, Legal, And Social Issues Raised By Voting By Persons With Dementia, Jason H. Karlawish, Richard J. Bonnie, Paul S. Appelbaum, Constantine Lyketsos, Bryan James, David Knopman, Christopher Patusky, Rosalie A. Kane, Pamela S. Karlan

Bryan G Kane MD

This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance …

Running Past Landmines--The Estate Attorney's Dilemma: Ethically Counseling The Client With Alzheimer's Disease, Joseph Karl Grant

Journal Publications

This Article examines the ethical dilemmas faced by attorneys who represent clients suffering from Alzheimer's disease. To do so, this Article raises three (3) hypothetical case studies,and applies the ABA Model Rules of Professional Conduct, and the American College of Trust and Estate Counsel ("ACTEC") Commentaries, where appropriate, to those hypothetical case studies. Additionally, this Article proposes initiatives to ameliorate the lack of awareness and discussion of Alzheimer's disease in the law school curriculum, and finally, modest initiatives that the practicing bar can embrace to further a discussion and awareness among practicing attorneys about the ethical dilemma attorneys face in …

Legal Capacity For All: Including Older Persons In The Shift From Adult Guardianship To Supported Decision-Making, Rebekah Diller

Faculty Articles

For the last several decades, guardianship has been the subject of continual calls for reform, often spurred by revelations of guardian malfeasance and other abuses in the system. Recent developments in international human rights law pose a more fundamental challenge to the institution. Under Article 12 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), governments may not deprive individuals of their “legal capacity”—or right to make decisions and have those decisions recognized as legally binding—on the grounds of disability. In the wake of the CRPD, the concept of supported decision-making has gained growing acceptance as …

Addressing The Ethical, Legal, And Social Issues Raised By Voting By Persons With Dementia, Jason H. Karlawish, Richard J. Bonnie, Paul S. Appelbaum, Constantine Lyketsos, Bryan James, David Knopman, Christopher Patusky, Rosalie A. Kane, Pamela S. Karlan

Jason Karlawish

This article addresses an emerging policy problem in the United States participation in the electoral process by citizens with dementia. At present, health care professionals, family caregivers, and long-term care staff lack adequate guidance to decide whether individuals with dementia should be precluded from or assisted in casting a ballot. Voting by persons with dementia raises a series of important questions about the autonomy of individuals with dementia, the integrity of the electoral process, and the prevention of fraud. Three subsidiary issues warrant special attention: development of a method to assess capacity to vote; identification of appropriate kinds of assistance …

The Medico-Legal Aspects Of Dementia-Driven Sexual Abuse In Nursing Homes, Lisa Tripp

Marquette Elder's Advisor

No abstract provided.

Alcoholism In Late Life: Some Issues, Richard E. Finlayson

Marquette Elder's Advisor

Alcoholism is a significant problem among the elderly. An undiagnosed, untreated older person may be mistaken as suffering from dementia. This article discusses problems in diagnosing elderly alcoholism, society's response to treatment of elderly alcoholics, and a comparison of early and late onset alcoholism in the elderly.

Late-State Dementia Care, Christine R. Kovach

Marquette Elder's Advisor

Dementia can be said to progress from early to mid to late stages. The rate of progression is variable, and the needs of the patients and the interventions required do evolve. Specific discussions include nutrition and hydration, behavioral aspects, care options, the use of the Medicare hospice benefit, and care units specially designed for late-stage dementia.

Joint Conference On Ethical/Legal Issues In The Progression Of Dementia, Carrie Mcadams

Marquette Elder's Advisor

No abstract provided.

Early-Stage Dementia Diagnosis And Care, Victor G. Valcour, Patricia L. Blanchette

Marquette Elder's Advisor

Dementia caused by Alzheimer's disease and other factors is taking a tremendous toll on elders and their families. According to the author however, if the disease is diagnosed and treated early, many patients can avoid or delay secondary medical and social complications.

Special Care Units: History, Regulation, And Criticism, Mollie Grande

Marquette Elder's Advisor

Special care units are nursing home areas dedicated to providing care for patients with dementia. This article describes the characteristics of individuals with dementia who need long-term care, outlines the reasons special care units were created, and discusses issues regarding their regulation.

Driving And Dementia: A Physician's Perspective, Megan C. Harney, Piero G. Antuono

Marquette Elder's Advisor

As one-tenth of adults over sixty-five and one-half of adults over eighty-five are diagnosed with Alzheimer's disease, the need to address the driving ability of such individuals grows as life expectancy increases. Different diagnoses of dementia are discussed, as are various tests which may help determine driving capability. Physicians and family members are urged to recommend re-testing when appropriate.

Unconscionable: Financial Exploitation Of Elderly Persons With Dementia, Matthew A. Christiansen

Marquette Elder's Advisor

Millions of people deal with the effects of dementia on an elderly family member. Individuals suffering from the effects of dementia are susceptible to financial abuse. This article chronicles the financial abuse of Gladys Smith, an elderly widow suffering from dementia, and the litigation that ensued. The article analyzes what had been done to protect Gladys's estate, what could have been done better, and provides suggestions for estate planning for vulnerable elderly to best prevent financial exploitation by 1) expecting the worst-case scenarios; 2) advanced planning; 3) periodic communication; 4) creating layers of protection to guard against the worst-case scenarios.

Aging In The United States: Rethinking Justice, Equality, And Identity Across The Lifespan, Nancy J. Knauer

Nancy J. Knauer

Our current aging policies and procedures raise profound questions of individual liberty, autonomy, and equality. Guardianship regimes require the state to balance the interests of vulnerable adults with their right to self-determination. The proliferation of age-specific laws designed to protect elders may actually compromise the civil rights of older individuals by denying their autonomy based solely on their age. The regulation of intimacy in long-term care settings infringes on a core liberty interest essential to human dignity. This essay introduces a new body of work that specifically addresses the civil rights aspects of aging. In many ways, aging represents the …

The Public Choice Of Driving Competence Regulations, Margaret F. Brinig

Journal Articles

Purpose: The purpose of this study is to describe and classify each state's driver's licensing laws and then test whether the licensing laws affect the percentages of over-64 persons licensed and the proportion of older drivers involved in accidents to determine an optimal level of driving.

Design and Methods: This paper evaluates state driving rules, obtained from laws, regulations, and driver's manuals, tests, based upon Department of Transportation data, whether the type of laws affects driving and accident rates for those over 64 and suggests a uniform scheme combining self-reporting of driving problems, on-the-road tests of drivers who fall below …