When people lose capacity to make a medical decision, the standard is to assess what their preferences would have been and try to honor their wishes. Dementia raises a special case in such situations, given its long, progressive trajectory during which others must make substituted judgments. The question of how to help surrogates make better‐informed decisions has led to the development of dementia‐specific advance directives, in which people are given tools to help them communicate what their preferences are while they are still able. Such directives allow the perspective of the person to play a clearer role in guiding decisions about their care. Dementia directives can never serve as rigid algorithms. Rather, they can be used to help inform conversations, to help surrogates make decisions that are better aligned with the preferences the person would have had. This essay lays out the proposed utility of dementia‐specific directives and addresses some of the criticisms raised about them.

中文翻译：

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指导未来：重新思考预先指示在痴呆症患者护理中的作用

当人们失去做出医疗决定的能力时，标准是评估他们的偏好并尽力尊重他们的意愿。痴呆症在这种情况下提出了一个特殊案例，因为它有漫长的、渐进的轨迹，在此期间其他人必须做出替代的判断。如何帮助代理人做出更明智的决定的问题导致了针对痴呆症的预先指示的发展，其中为人们提供了工具来帮助他们在有能力的情况下传达自己的偏好。这些指令使患者的观点能够在指导有关其护理的决策中发挥更清晰的作用。痴呆症指令永远不能充当严格的算法。相反，它们可以用来帮助为对话提供信息，帮助代理人做出更符合该人的偏好的决定。本文列出了针对痴呆症的指令的拟议用途，并解决了针对它们提出的一些批评。