Monday, April 2, 2001
Banking on the future
Major safety improvements to Baldwin Street begin
Campus dedications set for two historical markers
Mr. Adams goes to Washington
Professor helps coordinate project to produce ‘Healthy Grandparents’
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Health promotion and behavior head named to new state commission
Arch support
Coming together to tackle aging issues
By Kathy Pharr
pharr@uga.edu

The findings of a national multidisciplinary conference on the legal and ethical aspects of dementia, held at the Georgia Center for Continuing Education in December, are soon to be published. Columns spoke with Ned Spurgeon, the law professor who organized the conference, about its lasting impact.

Columns: Did the December conference on dementia meet your expectations?
Spurgeon: Actually, I’m pleased to say that it exceeded them. The legal and ethical issues associated with dementia, particularly Alzheimer’s disease, are subjects that demand involvement by multiple disciplines. They include the need for expertise in law and medicine--both practice and research--in social work, in gerontology and in bio-ethics. This conference brought together 75 national experts from all these disciplines. Therefore, the identification of the issues, the discussion of those issues, and the recommendations of the conference reflected that breadth and depth of thinking.

Columns: Who sponsored the conference?
Spurgeon: There were five sponsoring organizations: the University of Georgia School of Law; the Borchard Foundation Center on Law and Aging, of which I am the executive director; the Alzheimer’s Association; the American Bar Association’s Commission on Legal Problems of the Elderly; and the National Academy of Elder Law Attorneys.
This co-sponsorship contributed very positively to the interdisciplinary, multidisciplinary aspect of the conference in terms of identifying topics to explore as well as experts to invite to speak and contribute papers.
Professor Leonard Poon’s many contacts were also very helpful. Professor Poon directs UGA’s Gerontology Center and serves as an academic adviser to the Borchard Foundation Center on Law and Aging. His center offers a wonderful opportunity for collaborative programs; I know my annual law, public policy and aging seminars have been enriched by the enrollment of graduate students who are pursuing certificates in gerontology.

Columns: How was the conference structured?
Spurgeon: Working papers were written and distributed in advance on the topics that were considered in detail at the plenary and by break-out groups, and recommendations were voted on by the whole body.
We started the two-and-one-half-day working conference with a presentation on the etiology of Alzheimer’s disease by Dr. Peter Rabins of Johns Hopkins and a panel discussion exploring a dramatic case study--the poignant story of a vibrant woman who spent the last seven years of her life battling Alzheimer’s.
The account was told by her daughter, who served as her mother’s primary caregiver, and the discussion was very helpful in identifying the major issues that are confronted during the course of Alzheimer’s disease: medical issues, ethical issues, treatment issues and decision-making issues. It set the scene and provided context for the working groups to consider a wide variety of issues.

Columns: What are some of the conference recommendations?
Spurgeon: They cover a very broad spectrum in the areas of policy, law reform, practice guidelines, and topics for further study.
One important recommendation is that we need to support efforts to simplify and make uniform as much as possible the state laws which allow an individual to provide an advance health-care directive and to open the lines of communication between the individual to the doctors and family members about what he or she wants done; just having a bare-bones advance directive is often inadequate.
One group considered issues of personal autonomy vs. public safety and recommended that the diagnosis of Alzheimer’s disease should not automatically result in the loss of driving privileges, nor should there be mandatory reporting of such persons to the Department of Motor Vehicles.
Another very important conference recommendation deals with genetic discrimination: it should be a matter of public policy to forbid discriminatory rate-setting by insurance companies for long-term-care insurance based upon the predisposition that one may have, because of other family members having had dementia. These are just a few of many recommendations.

Columns: How will the conference findings be shared?
Spurgeon: The recommendations, along with 10 working papers that were the basis for the conference, are being published in a special symposium issue of the Georgia Law Review this spring.
The five sponsoring organizations will also work to ensure wide dissemination to academics and practicing lawyers, to doctors, to policy makers, to social-service providers and bio-ethicists, among others, all of whom are interested in better ways to care for people with progressive dementia and to help their families.

Columns: What do you hope the conference accomplished?
Spurgeon: I hope the dementia conference will inspire lively debate and ultimately policy and best-practices direction on these various topics throughout the country.
The recommendations should serve as a blueprint for the development of policy, laws, practice guidelines and further research studies over the next decade.
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