![]() This critique of flaws may serve as a guide to drafting and to selecting effective and acceptable advance directives for dementia. These strategies may prevent authorities from requiring patients to fulfill authorities’ additional clinical criteria as a prerequisite to honor the requests in patients directives. ![]() This article proposes a protocol to prevent this conflict from emerging. ![]() No directive critiqued here included an effective strategy to resolve this long-debated bioethical conflict: the past directive requests “Cease assisted feeding” but the incapacitated patient apparently expresses the desire to “Continue assisted feeding.” Some opponents to the controversial request, cease assisted feeding, use this conflict as a conceptual wedge to practice hard paternalism. The article includes excerpts from “dementia-specific” directives or supplements that exemplify each flaw-mostly from the US and Europe. Strategies are needed to compel physicians to write needed orders and to prevent third parties from sabotaging these orders after they are implemented. Inherent flaws can make advance directives unacceptable to authorities concerned about premature dying. Content flaws reflect drafters’ selection of conditions and interventions, and how they are described. Process flaws focus on how patients express their end-of-life wishes. This article considers 24 common advance directive flaws in four categories. A single flaw can provide opponents justification to refuse the directive’s requests to cease assisted feeding. While advance directives can be patients’ last resort to attain a peaceful and timely dying consistent with their lifelong values, success depends on their being effective and acceptable. Proxies/agents’ substituted judgment may not be concordant with patients’ requests. ![]() Physicians and judges can insist on clear and convincing evidence that the patient wants to die-which many advance directives cannot provide. Options to avoid prolonged dying are limited since advanced dementia patients cannot qualify for Medical Aid in Dying. The terminal illness of late-stage (advanced) Alzheimer’s and related dementias is progressively cruel, burdensome, and can last years if caregivers assist oral feeding and hydrating. On the basis of reports by nurses, patients in hospice care who voluntarily choose to refuse food and fluids are elderly, no longer find meaning in living, and usually die a "good" death within two weeks after stopping food and fluids. 64 years of age, P<0.001), less likely to want to control the circumstances of their death (P<0.001), and less likely to be evaluated by a mental health professional (9 percent vs. On the basis of the hospice nurses' reports, the patients who stopped eating and drinking were older than 55 patients who died by physician-assisted suicide (74 vs. On a scale from 0 (a very bad death) to 9 (a very good death), the median score for the quality of these deaths, as rated by the nurses, was 8. The survey showed that 85 percent of patients died within 15 days after stopping food and fluids. Nurses reported that patients chose to stop eating and drinking because they were ready to die, saw continued existence as pointless, and considered their quality of life poor. Of 429 eligible nurses, 307 (72 percent) returned the questionnaire, and 102 of the respondents (33 percent) reported that in the previous four years they had cared for a patient who deliberately hastened death by voluntary refusal of food and fluids. We mailed a questionnaire to all nurses employed by hospice programs in Oregon and analyzed the results. There are few reports of patients who have made this choice. Voluntary refusal of food and fluids has been proposed as an alternative to physician-assisted suicide for terminally ill patients who wish to hasten death.
0 Comments
Leave a Reply. |