Advance directives are legally recognized documents that specify care if a person is incapacitated. They can confirm that a patient doesn’t want to be resuscitated or kept on mechanical life support, such as a ventilator or feeding tube, if they have a terminal condition from which they’re not likely to recover.

The National Review had an interesting article discussing an NPR story on “aggressive advance directive” that would force nursing homes to starve dementia patients — even if they are willing and able to eat — when they reach a specified stage of cognitive decline. The directive, finalized by the board for End Of Life Choices New York, aims to provide patients a way to hasten death in late-stage dementia, if they choose.

The document offers two options. One option is a request for “comfort feeding” — providing oral food and water if a patient appears to enjoy or allows it during the final stages of the disease. Another alternative would halt all assisted eating and drinking, even if a patient seems willing to accept it.  The options would be invoked only when a patient is diagnosed with moderate or severe dementia, defined as Stages 6 or 7 of a widely used test known as the Functional Assessment Staging Tool (FAST). At those stages, patients would be unable to feed themselves or make health care decisions.

 

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