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Dementia poses an enormous ethical problem to U.S. society and to other societies and cultures in the world. The "old old" are the fastest-growing segment of our population, and dementia is alarmingly prevalent in this group. The most common dementias are inevitably fatal after there has been a decade or more of progressive intellectual and physical deterioration. The great majority of patients with dementia spend their final years in nursing homes, bed-bound, incontinent, unable to recognize their family members, and unaware even of their own identities. The issues such patients raise are extreme versions of problems we now face in
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