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The implausibility of response shifts in dementia patients
  1. Karin Rolanda Jongsma1,2,
  2. Mirjam A G Sprangers3,
  3. Suzanne van de Vathorst1
  1. 1Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
  2. 2Medical Ethics and History of Medicine, University Medical Center Georg-August University, Göttingen, Germany
  3. 3Department of Medical Psychology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Karin Rolanda Jongsma, Medical Ethics and Philosophy of Medicine, Erasmus University Medical Center, Rotterdam 3000 CA, The Netherlands; karin.jongsma{at}


Dementia patients may express wishes that do not conform to or contradict earlier expressed preferences. Our understanding of the difference between their prior preferences and current wishes has important consequences for the way we deal with advance directives. Some bioethicists and gerontologists have argued that dementia patients change because they undergo a ‘response shift’. In this paper we question this assumption. We will show that proponents of the response shift use the term imprecisely and that response shift is not the right model to explain what happens to dementia patients. We propose a different explanation for the changed wishes of dementia patients and conclude that advance directives of dementia patients cannot be simply put aside.

  • Dementia
  • Decision-making
  • Clinical Ethics
  • Living Wills/Advance Directives
  • Quality/Value of Life/Personhood

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