Navigation Links
Exploring a legal and ethical gray area for people with dementia
Date:6/5/2014

(Garrison, NY) Many of the legal and ethical options for refusing unwanted interventions are not available to people with dementia because they lack decision-making capacity. But one way for these people to ensure that they do not live for years with severe dementia is to use an advance directive to instruct caregivers to stop giving them food and water by mouth. This is an ethical and legal gray area explored in commentaries and a case study in the Hastings Center Report.

People with decision-making capacity have the legal right to refuse treatment of any kind and to voluntarily stop eating and drinking. In states where physician aid in dying is legal, people with decision-making capacity who are terminally ill can ask a doctor to help them end their lives. For people who lose decision-making capacity, an advance directive can express their wish to refuse life support, including a feeding tube. But it is questionable whether there is a legal right to use an advance directive to refuse food and water given by mouth when a person can still swallow but lacks decision-making capacity.

In the lead article in the May-June issue, Paul T. Menzel and M. Colette Chandler-Cramer express support for such directives and say that they "are arguably already legal" because they follow logically from the legal rights to refuse life support and to voluntarily stop eating and drinking. Menzel, a professor of philosophy emeritus at Pacific Lutheran University, and Chandler-Cramer, a retired physician assistant and a member of a hospital hospice team in Washington State, propose guidelines for implementing such directives so as to guard against misunderstanding and abuse, and they offer a sample advance directive.

A commentary by Rebecca Dresser calls the proposal "both appealing and unsettling." Dresser, who is Daniel Noyes Kirby Professor of Law and professor of ethics in medicine at Washington University in St. Louis, writes that this use of an advance directive "is appealing because it offers some relief to people seeking to avoid the prolonged decline and extreme incapacity they have witnessed in relatives and friends with advanced dementia," but she cautions that it fails to protect incompetent patients.

A case study with commentaries concerns a 75-year-old woman with Alzheimer's disease who, in discussions with her husband, "was adamant about not coming to the point where she would be unable to recognize herself, her husband, or their son and daughter." She made a plan to voluntarily stop eating and drinking on a specific date. "She asked her husband to promise, should she ever waver and request nutrition or hydration, to remind her of the reasons she had chosen for pursuing this path," said the case study. However, after voluntarily stopping eating and drinking, the women asked her caregivers friends and hired professionals for food and drink. While she sometimes exhibited decision-making capacity, she often did not recall having chosen VSED.

The commentaries explore whether health care workers can follow a family member's request to honor their loved one's VSED plan when the patient's advanced dementia makes disciplined voluntary action difficult. The commentaries are written by Ross Fewing, director of ethics at St. Joseph Medical Center in the PeaceHealth System in the Pacific Northwest; Timothy W. Kirk, an assistant professor of philosophy at City University of New York, York College; and Alan Meisel, the Dickie, McCamey and Chilcote Professor of Bioethics and professor of law at the University of Pittsburgh Schools of Medicine and Law.


'/>"/>

Contact: Susan Gilbert
gilberts@thehastingscenter.org
845-424-4040 x244
The Hastings Center
Source:Eurekalert

Related medicine news :

1. Nuanced Media Client, Andrea Blatterg of of ABC Senior Placement Advisors Presents: Wildflower Group’s November Event, "Exploring the Allure of Senior Living"
2. EmpowHER’s Michelle King Robson Announces Launch of HER Radio – Exploring all things Woman
3. Sofia University Hosts Exploring O’Sensei’s Aikido & Zen Calligraphy Workshop
4. Agenda Announced for the BioTechniques 2013 Virtual Symposium on Exploring the Modern Lab
5. Outlook with Ben Kingsley Exploring Sports Injuries in Children
6. Outlook with Ben Kingsley Exploring Role of Nanotechnology in Medicine for Upcoming Report
7. Cola and honey: Exploring food riddles in rhythm disturbances
8. Impact with Martin Sheen Exploring Molecular Medicine in a New Report
9. Yeast Infection No More: Review Exploring Linda Allen's Holistic Yeast Infection Treatment Released
10. Registration Opens for the 2013 BioTechniques Virtual Symposium—Exploring the Modern Lab
11. revitaRUGS Will Be “Exploring Universal Design” as a Sponsor at the ASID Forum in New York City
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/26/2016)... (PRWEB) , ... June 27, 2016 , ... Quality metrics ... yet in many ways they remain in the eye of the beholder, according to ... a publication of The American Journal of Managed Care. For the full issue, ...
(Date:6/26/2016)... North Carolina (PRWEB) , ... June 26, 2016 , ... ... release of a new product that was developed to enhance the health of felines. ... for centuries. , The two main herbs in the PawPaws Cat Kidney Support ...
(Date:6/25/2016)... ... 25, 2016 , ... Experts from the American Institutes for ... Meeting June 26-28, 2016, at the Hynes Convention Center in Boston. , AIR ... care planning, healthcare costs and patient and family engagement. , AIR researchers will ...
(Date:6/25/2016)... ... June 25, 2016 , ... "With 30 hand-drawn hand gesture animations, FCPX ... Austin - CEO of Pixel Film Studios. , ProHand Cartoon’s package transforms over ... Cut Pro X . Simply select a ProHand generator and drag it above media ...
(Date:6/25/2016)... (PRWEB) , ... June 25, 2016 , ... ... athletes and non-athletes recover from injury. Recently, he has implemented orthobiologic procedures as ... City area —Johnson is one of the first doctors to perform the treatment. ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... June 24, 2016  Arkis BioSciences, a leading ... and more durable cerebrospinal fluid treatments, today announced ... Series-A funding is led by Innova Memphis, followed ... other private investors.  Arkis, new financing will accelerate ... the market release of its in-licensed Endexo® technology. ...
(Date:6/23/2016)... a startling report released today, National Safety Council research ... proven plan to eliminate prescription opioid overdoses. Prescription Nation ... tackling the worst drug crisis in recorded U.S. history, assigned a ... , New Mexico , Tennessee ... failing states, three – Michigan , ...
(Date:6/23/2016)... WAYNE, Pa. , June 23, 2016 ... provider, will launch its next generation clinical outcomes platform, Bracket ... DIA Meeting held on June 26 – 30, 2016 in ... 6.0, the first electronic Clinical Outcome Assessment product of its ... DIA Booth #715. Bracket eCOA 6.0 is a ...
Breaking Medicine Technology: