A diagnosis of dementia should be used with caution. All potential causes of reversibility need to be ruled out. The label of dementia causes a cascade of other issues to surface. Clinicians often do not understand this. Once the dementia label is attached there are or will be decision making issues that are medical, legal, financial and safety related. Just because one has a dementia diagnosis does not mean they are unable to make decisions. Can the person with dementia continue to make safe and self sustaining decisions? Who makes the decision about when they cannot make decisions? When are they no longer safe to make their own decisions?