Medical treatment of people with dementia requires dealing with uncertainty

Here we report on a number of medical dilemmas during the final 6 years of life of a 78-year-old woman with dementia. Questions concerning both diagnostic procedures and treatment options are discussed. The first dilemma concerns mild symptoms leading to the diagnosis of paroxysmal atrial fibrillation and the requirement for anticoagulation; the second dilemma concerns vague symptoms of tiredness with anaemia leading to the diagnosis of colon cancer and the requirement for surgery. The conclusion is that there are no protocols that can be used to solve questions of this nature, and we need careful reflection with colleagues, the patient and important people in the patient's life in order to make decisions in the best interest of the quality of life as experienced by the patient. This is a complicated task for any doctor who has to deal with medical uncertainties and an incapacitated patient.