Dementia, Decision-Making, and the Modern (Adult) Guardianship Paradigm: Bentley v Maplewood Seniors Care Society

AuthorMargaret Isabel Hall
PositionAssistant Professor, Faculty of Law, Thompson Rivers University
(2015) 1 CJCCL 293
Dementia, Decision-Making, and
the Modern (Adult) Guardianship
Paradigm: Bentley v Maplewood
Seniors Care Society
Margaret Isabel Hall*
is paper considers the meaning of decision-making, including substitute decision-
making, for persons with dementia.  e paper discusses the historical development of
adult guardianship, from the King’s stewardship of the property of “fools” and “lunatics”
to the modern mechanisms of substitute decision-making, and the relationship between
substitute decision-making and a particular ideal of autonomy.  e paper concludes with
a discussion of Bentley v Maplewood Seniors Care Society, a case concerning the
present choices of a woman with dementia, the decisions set out in the “living will” she
drafted many years earlier (prior to dementia), and the decisions made by the woman’s
(purported) representatives on her behalf.  e case invites us to consider whether the
decisions of the former, mentally capable self can ever trump the choices of the current
self with dementia.
* Assistant Professor, Faculty of Law,  ompson Rivers University.
Hall, Dementia, Decision-Making, and the Modern (Adult) Guardianship
I. I
II. A T D-M: T M A G
III. H C: S  M P
IV. S D: M’ S
VI. C
I. Introduction
The case of Bentley v Maplewood
1 raises a number of profound questions
about the nature of self in dementia, the nature and signi cance of
“decisions” and “decision-making,” and the role of substitute decision-
makers (including the former self through an advance directive) vis-à-vis
the person with dementia. What is the nature of consent for an individual
with advanced dementia, who departs in dramatic physical and mental
ways from the norm (including his or her former “normal” self), and how
can it be recognised? Should consent ever be separated from decision-
making and if so, why and under what circumstances? What are the
ethical implications of enabling a former self to make life terminating
decisions on behalf of a fundamentally changed present self? What is
the role of the individual’s representative in this situation? As Ronald
Dworkin would have it (see discussion, infra), should a person’s prior
(intellectual) decision override contrary (embodied) behaviour by the
present self-with-dementia? What is “decision-making” and why does it
is article considers the issues raised by the Bentley case, as they
both illustrate and challenge the modern adult guardianship paradigm.
1. 2014 BCSC 165 [Bentley].

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