Whether intentionally or inadvertently, a recent article in the Washington Post, written by a reporter with Kaiser Health News, provides confusing, incomplete, misleading, and perhaps inaccurate information about the choices a person with dementia may have. It dismisses legal issues by citing opinions from non-legal professionals.
On this blog, we have dealt often with aspects of advance directives. To prepare for using a dementia directive, readers may benefit from a discussion of the development of advance directives and problems with their language. References to several dementia directives or supplements are provided.
Since the 1970s there have been debates about whether “patients” have the right to refuse various forms of life-saving or life-sustaining medical treatment, ranging from blood transfusions to ventilators and feeding tubes. More recently the debate has moved into the area of dementia and which, if any, kinds of treatment may be refused under the terms of a directive written in advance of loss of decision-making capacity. The issue of forced feeding is addressed by several articles in the July/August issue (48:4) of the Hastings Center Report, one of the nation’s preeminent bioethics publications.
In Part 2 of this post about dementia, disability, and advance directives, Lamar Hankins challenges Dresser's assertion that an advance directive that calls for allowing a person to die in the later stages of dementia should be ignored in favor of her view of what care is appropriate.
Developments since 1997 in accepted medical practice regarding voluntarily stopping eating and drinking (VSED) and terminal sedation (TS) warrant fresh claims that state exclusion of lethal assistance to a competent, fatally stricken patient is so arbitrary as to violate equal protection of the laws under state and federal constitutions. While the prevailing jurisprudence for the past 20 years has upheld state bans on lethal poisons as a mode of protecting a vulnerable population (dying patients) against abuse or mistake, there are at least 2 cogent counter arguments in any renewed constitutional debate.
