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Controversy of End-of-Life Directives by Dementia Patients

We have posted about numerous cases about the elderly and dementia and Alzheimer’s. Alzheimer’s affects millions across the country, and many reside in nursing homes and long-term, care facilities in order to ensure they are cared for and have a good quality of life even as they no longer have all of their mental faculties. We have also previously discussed how many nursing home patients, much like hospital or other patients in general, have certain preferences about their treatment in the event of certain circumstances.

This may include a wish to not be resuscitated in certain circumstances. The elderly or infirmed may decide that they wish not to live if certain circumstances will make it too much to bear. In one particular case profiled by the New York Times, an elderly Massachusetts man, who has a particularly specific “advance directive” that instructs medical providers, first responders or paramedics of what to do in certain scenarios.

For example, if he is terminally ill, he does not want to be put on a ventilator, be given a feeding tube, or be administered cardiopulmonary (CPR) resuscitation. In the event he is found to have some dementia or Alzheimer’s that affects his ability to feed himself, he does not want “ordinary means of nutrition and hydration,” essentially meaning that he does not want to be provided nutrition through liquids or spoon-feeding. This is analogously another means of not being kept alive, much similar in a sense to a “do not resuscitate” instruction or order, albeit it leads to a slower demise. As the article indicates, about 30% of the elderly above age 85 suffer from some type of dementia, and this disease continues to affect many Americans in general.

The Decision-Making Controversy

This type of directive has stirred debate and controversy, as some advocate for one’s ability to decide how they should live out the rest of their life, or how they should die, if put in certain situations such as with dementia or a terminal illness. Others, however, believe it unethical for those around the person, and namely doctors and medical providers, to allow this to happen and not intervene to keep them alive.

There is thus a tremendous tension between an obligation to do the best for a patient, and that patient’s own personal wishes decided before the triggering affliction or circumstances occur. The patients ultimately do not want to be put through that, particularly where there is pain, and do not want loved ones to have to deal with it either. There has been a slow movement for the elderly and infirmed to “die with dignity,” but such laws exist only in a handful of states (Oregon’s was brought to light nationally when a 29 year old moved there since the law would allow her to take lethal medication rather than suffer through terminal brain cancer). But reportedly these laws do not appear to cover dementia patients.

The debate here will undoubtedly rage on particularly as these directives apply to dementia patients. It not only will be a controversy of whether to legally permit such directives, but also to what extent they are applicable, and what degrees of dementia and incapacity may qualify someone to order that normal food and liquid nourishment methods be cut off. This will be a major issue not just in nursing homes and facilities but with elder care altogether.

See Other Blog Posts:

Elder Care Business – Privatizing Nursing Home Care

Senior Chicago Resident Dies from Building Fire