<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0034-7450</journal-id>
<journal-title><![CDATA[Revista Colombiana de Psiquiatría]]></journal-title>
<abbrev-journal-title><![CDATA[rev.colomb.psiquiatr.]]></abbrev-journal-title>
<issn>0034-7450</issn>
<publisher>
<publisher-name><![CDATA[Asociacion Colombiana de Psiquiatria.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0034-74502024000300295</article-id>
<article-id pub-id-type="doi">10.1016/j.rcp.2022.11.002</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Dilemas y ética del cuidado: conservar y cuidar la autonomía de la persona con demencia]]></article-title>
<article-title xml:lang="en"><![CDATA[Dilemmas and Ethics of Care: Conserving and Caring for the Autonomy of the Person with Dementia]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Moutran Barroso]]></surname>
<given-names><![CDATA[Habib Georges]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad El Bosque Neurología Clínica ]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2024</year>
</pub-date>
<volume>53</volume>
<numero>3</numero>
<fpage>295</fpage>
<lpage>301</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0034-74502024000300295&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0034-74502024000300295&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0034-74502024000300295&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN  Introducción:  Las demencias constituyen un grupo de enfermedades que afectan notoriamente a las personas que las padecen, especialmente en términos de su independencia y toma de decisiones, llevando a que el cuidador asuma o tome varias decisiones sobre el paciente. No obstante, en el pasado esto se veía explicado porque había una insuficiencia teórica y narrativa en torno a los pacientes con demencia, lo que conllevaba a ignorar que todavía conservaban su capacidad de toma de decisiones, así como su autonomía.  Objetivo:  Este texto defiende la existencia de la autonomía en estos pacientes y una vía acerca de cómo podemos cuidarla y preservarla en el ámbito médico, a través de una posición ética fundamentada en el cuidado y el reconocimiento de la vulnerabilidad.  Metodología:  Se realizó un abordaje enfocado en la ética del cuidado y de la vulnerabilidad de Ronald Dworkin, Emmanuel Levinas y Corine Pelluchon centrado en la persona con demencia. Posteriormente introduje un instrumento que permite valorar la autonomía y la toma de decisiones en personas con demencia.  Resultados y discusión:  Para garantizar la dignidad de la persona con demencia hay que comprender la manera en cómo es autónoma, en términos de autogobernanza y buscando disminuir las asimetrías en las relaciones. Además de incluir siempre a los cuidadores y a los familiares dentro de la toma de decisiones.  Conclusiones:  Las personas con demencia son autónomas en un sentido individual o personal y merecen respeto. Aunque estén en un estado de vulnerabilidad, hay diferentes mecanismos enfocados en su cuidado.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT  Introduction:  Dementias constitute a group of diseases that notoriously affect people who suffer from them, especially in terms of their independence and decision-making, leading the caregiver to assume or make various decisions about the patient. However, in the past this was explained by the fact that there was a theoretical and narrative insufficiency around patients with dementia, which led us to ignore that they still conserved their decision-making capacity as well as their autonomy.  Objective:  This text proposes to defend the existence of autonomy in these patients and a way about how we can take care of it and preserve it in the medical field, through an ethical position based on the care and recognition of vulnerability.  Methodology:  An approach focused on the ethics of care and vulnerability by Ronald Dworkin, Emmanuel Levinas and Corine Pelluchon focused on the person with dementia. I introduced a scale that allows assessing autonomy and decision-making in people with dementia.  Results and discussion:  To guarantee the dignity of the person with dementia, it is necessary to understand how they are autonomous, in terms of self-governance and seeking to reduce asymmetries in relationships. In addition, always include caregivers and family members in decision-making.  Conclusions:  People with dementia are autonomous in an individual or personal sense and deserve respect. Although they are in a state of vulnerability, there are different mechanisms focused on their care.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Autonomía]]></kwd>
<kwd lng="es"><![CDATA[Dignidad]]></kwd>
<kwd lng="es"><![CDATA[Vulnerabilidad]]></kwd>
<kwd lng="es"><![CDATA[Demencia]]></kwd>
<kwd lng="es"><![CDATA[Cuidado]]></kwd>
<kwd lng="en"><![CDATA[Autonomy]]></kwd>
<kwd lng="en"><![CDATA[Dignity]]></kwd>
<kwd lng="en"><![CDATA[Vulnerability]]></kwd>
<kwd lng="en"><![CDATA[Dementia]]></kwd>
<kwd lng="en"><![CDATA[Care]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Livingston]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Sommerlad]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Orgeta]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Costafreda]]></surname>
<given-names><![CDATA[SG]]></given-names>
</name>
<name>
<surname><![CDATA[Huntley]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Ames]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dementia prevention, intervention, and care.]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>2017</year>
<numero>390</numero>
<issue>390</issue>
<page-range>2673-734</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Livingston]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Huntley]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Sommerlad]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Ames]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Ballard]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Banerjee]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dementia prevention, intervention, and care: 2020 report of the Lancet Commission]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>2020</year>
<numero>396</numero>
<issue>396</issue>
<page-range>413-46</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Casas Martínez]]></surname>
<given-names><![CDATA[ML]]></given-names>
</name>
<name>
<surname><![CDATA[Zúñiga]]></surname>
<given-names><![CDATA[T.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[El respeto a la autonomía en el manejo de ancianos con demencia.]]></article-title>
<source><![CDATA[Rev Colomb Bioet]]></source>
<year>2017</year>
<numero>12</numero>
<issue>12</issue>
<page-range>40-8</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mullin]]></surname>
<given-names><![CDATA[A.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Children, autonomy, and care]]></article-title>
<source><![CDATA[J Soc Philos]]></source>
<year>2007</year>
<numero>38</numero>
<issue>38</issue>
<page-range>536-53</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mullin]]></surname>
<given-names><![CDATA[A.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Children and the argument from 'marginal' cases]]></article-title>
<source><![CDATA[Ethical Theory Moral Pract]]></source>
<year>2011</year>
<numero>14</numero>
<issue>14</issue>
<page-range>291-305</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Foster]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Butler]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Occupational therapists' understanding of autonomy for people with dementia]]></article-title>
<source><![CDATA[Int J Innov Res Sci Eng Technol]]></source>
<year>2017</year>
<numero>2</numero>
<issue>2</issue>
<page-range>1583-90</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Levinas]]></surname>
<given-names><![CDATA[E.]]></given-names>
</name>
</person-group>
<source><![CDATA[De otro modo que ser o más allá de la esencia]]></source>
<year>2003</year>
<edition>4</edition>
<publisher-loc><![CDATA[Salamanca, España ]]></publisher-loc>
<publisher-name><![CDATA[Ediciones Sígueme]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dworkin]]></surname>
<given-names><![CDATA[R.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Autonomy and the demented self.]]></article-title>
<source><![CDATA[Milbank Q]]></source>
<year>1986</year>
<numero>64</numero>
<issue>64</issue>
<page-range>4-16</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Fernández Guerrero]]></surname>
<given-names><![CDATA[O.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Levinas y la alteridad: cinco planos]]></article-title>
<source><![CDATA[Brocar. Cuadernos de Investigación Histórica]]></source>
<year>2015</year>
<page-range>423-43</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bentwich]]></surname>
<given-names><![CDATA[ME]]></given-names>
</name>
<name>
<surname><![CDATA[Dickman]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Oberman]]></surname>
<given-names><![CDATA[A.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Autonomy and dignity of patients with dementia: Perception of multicultural caretakers]]></article-title>
<source><![CDATA[Nurs Ethics]]></source>
<year>2018</year>
<numero>25</numero>
<issue>25</issue>
<page-range>37-53</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Pelluchon]]></surname>
<given-names><![CDATA[C.]]></given-names>
</name>
</person-group>
<source><![CDATA[La autonomía quebrada]]></source>
<year>2011</year>
<edition>1</edition>
<publisher-loc><![CDATA[Bogotá Colombia ]]></publisher-loc>
<publisher-name><![CDATA[Colección BIOS y OIKOS]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Moreno]]></surname>
<given-names><![CDATA[A.]]></given-names>
</name>
</person-group>
<source><![CDATA[La ética de la vulnerabilidad de Corine Pelluchon]]></source>
<year>2013</year>
<page-range>171-8</page-range><publisher-loc><![CDATA[Daimon ]]></publisher-loc>
<publisher-name><![CDATA[Revista Internacional de Filosofía]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Warren]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Moral Status: Obligations to Persons and Other Living Things]]></article-title>
<source><![CDATA[Clarendon Press;]]></source>
<year>1997</year>
</nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gilligan]]></surname>
<given-names><![CDATA[C.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[La moral y la teoría]]></article-title>
<source><![CDATA[Psicología del desarrollo femenino]]></source>
<year>1986</year>
<publisher-loc><![CDATA[México D.F. ]]></publisher-loc>
<publisher-name><![CDATA[Fondo de Cultura Económica]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rawls]]></surname>
<given-names><![CDATA[J.]]></given-names>
</name>
</person-group>
<source><![CDATA[La justicia como equidad: Una reformulación]]></source>
<year>2002</year>
<publisher-loc><![CDATA[Madrid, España ]]></publisher-loc>
<publisher-name><![CDATA[Ediciones Paidós]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Villar]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Serrat]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Bravo-Segal]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Giving them a voice: Challenges to narrative agency in people with dementia]]></article-title>
<source><![CDATA[Geriatrics (Basel).]]></source>
<year>2019</year>
<numero>4</numero>
<issue>4</issue>
<page-range>20</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Koza]]></surname>
<given-names><![CDATA[K.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dementia, autonomy, and unexpected happiness]]></article-title>
<source><![CDATA[Undergraduate Journal of Humanistic Studies]]></source>
<year>2016</year>
<numero>3</numero>
<issue>3</issue>
<page-range>1-5</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Walker]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[McMillan]]></surname>
<given-names><![CDATA[J.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Memory identity and dementia.]]></article-title>
<person-group person-group-type="editor">
<name>
<surname><![CDATA[Schramme]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Edwards]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<source><![CDATA[Handbook of the Philosophy of Medicine]]></source>
<year>2017</year>
<page-range>359-70</page-range><publisher-loc><![CDATA[Nueva Zelanda ]]></publisher-loc>
<publisher-name><![CDATA[Springer]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wilkins]]></surname>
<given-names><![CDATA[JM.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Dementia, decision making, and quality of life]]></article-title>
<source><![CDATA[AMA J Ethics.]]></source>
<year>2017</year>
<numero>19</numero>
<issue>19</issue>
<page-range>637-9</page-range></nlm-citation>
</ref>
<ref id="B20">
<label>20</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Groesmayer]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Has the person with dementia lost the right to autonomy? A discussion of Ronald Dworkin's view on the moral status of the advance directive]]></article-title>
<source><![CDATA[Umeå Universitet]]></source>
<year>2015</year>
</nlm-citation>
</ref>
<ref id="B21">
<label>21</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Alvarez Marrodán]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Baón Pérez]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Navío Acosta]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[López-Antón]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Lobo Escolar]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Ventura Faci]]></surname>
<given-names><![CDATA[T.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Validación espaínola de la entrevista MacArthur Competence Assessment Tool for Treatment para evaluar l capacidad de los pacientes para consentir tratamiento]]></article-title>
<source><![CDATA[Med Clin (Barc).]]></source>
<year>2014</year>
<numero>143</numero>
<issue>143</issue>
<page-range>201-4</page-range></nlm-citation>
</ref>
<ref id="B22">
<label>22</label><nlm-citation citation-type="book">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Grisso]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Appelbaum]]></surname>
<given-names><![CDATA[PS.]]></given-names>
</name>
</person-group>
<source><![CDATA[MacArthur Competence Assessment Tool for Treatment (MacCat-T).]]></source>
<year>1998</year>
<publisher-loc><![CDATA[Sarasota, FL, US ]]></publisher-loc>
<publisher-name><![CDATA[Professional Resource Press/Professional Resource Exchange]]></publisher-name>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
