Health Care Analysis 30 (1):57-72 (2022)

Abstract
Patients with advanced dementia are less likely than those with other terminal illnesses to receive palliative care. Due to the nature and course of dementia, there may be a failure to recognize the terminal stage of the disease. A possible and under-investigated explanation for this healthcare disparity is the healthcare practitioner who plays a primary role in end-of-life decision-making. Two potential areas that might impact provider decision-making are cognitive biases and moral considerations. In this analysis, we demonstrate how the cognitive biases and moral considerations of practitioners related to clinical decision-making are inherent in clinical practice and may impact on providers’ accuracy related to diagnostic and treatment related decision-making associated with patients with advanced dementia. Anchoring, default, availability, representativeness and framing biases are cognitive biases based on the "Two System Model" that relate to decision-making in end-of-life care. In patients with advanced dementia, those biases may result in a tendency to adhere to traditional mandatory care, involving an aggressive approach to care, which values saving lives at all costs, without taking into account the possible suffering and long-term consequences. Aspects such as moral sensitivity and moral courage play an important role in ethical decision-making related to advanced dementia. Investigations of clinical decision-making that include the cognitive biases and ethical considerations of practitioners might advance the comprehensive understanding of the clinical decision-making process related to care of patients with advanced dementia and promote the quality of care given to this population.
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DOI 10.1007/s10728-021-00429-x
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References found in this work BETA

Thinking, Fast and Slow.Daniel Kahneman - 2011 - New York: New York: Farrar, Straus and Giroux.
Ethics and Intuitions.Peter Singer - 2005 - The Journal of Ethics 9 (3-4):331-352.
The Secret Joke of Kant’s Soul.Joshua Greene - 2007 - In W. Sinnott-Armstrong (ed.), Moral Psychology, Vol. 3. MIT Press.

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