Can an effective end‐of‐life intervention for advanced dementia be viewed as moral?

Alzheimer's disease (AD) is the most common cause of dementia, a general term for memory loss and decline in other cognitive abilities enough to interfere with daily life. AD accounts for 60% to 80% of dementia cases. The late stage of AD tends to be the shortest stage and, on average, lasts 1 to 2 years. As this stage of the condition progresses, it requires continuous intensive long‐term care and around‐the‐clock intensive care. The Alzheimer's Association stands firm in its commitment to supporting individuals living with AD and other dementia, their care partners, and their health‐care providers as they navigate treatment and care decisions across the continuum of the disease. This article is a direct response to recently published works that run counter to the Association's viewpoint. It outlines the Association's perspective on crucial factors for consideration during late‐stage dementia care, including advanced directives, palliative care, nutrition, and legal considerations. It explores diverse perspectives from the field, differing from the Alzheimer's Association's stance. Last, it underscores resources available through the Alzheimer's Association, aiming to present a comprehensive perspective on late‐stage care for support and assistance to all involved.

Section: Aspect Of Care To Consider-nutritionmentioning

confidence: 99%

“…The authors even contemplate the possibility of politicians adopting stringent measures, posing a threat to individual rights and the risk of national dementia-driven medical bankruptcy. 3 These views are against the stance of the Alzheimer's Association.…”

Section: Legal Considerations For End-of-life Carementioning

confidence: 99%

Navigating late‐stage dementia: A perspective from the Alzheimer's Association

Clifford,

Moreno,

Kloske

2024

“…Terman intends to stimulate debate on patient advance directive withheld assisted feeding for advanced dementia patients whose suffering exceeds what quality of life remains. 1 He presents arguments from those who support withholding feeding assistance and from those who argue that doing this is immoral. Dr. Terman hopes to persuade physicians caring for persons living with advanced dementia (PLADs) that to withhold assisted feeding under the right circumstances is not immoral.…”

Section: Introductionmentioning

confidence: 99%

Fasting to stop suffering in advanced dementia

Allen

2024

Many healthcare providers think withholding food and fluids from advance dementia patients, even if those patients requested that when competent, is immoral. This means such patients suffer unnecessarily long. Patients have the ethical right when capacitated to specify that they want assistance with food and drink stopped when they have advanced dementia. Physicians should implement these patient choices when advance dementia patients can no longer feed themselves. In some states there may be legal barriers to this practice.The perpetual placement of food and drink within reach of patients who are unable to feed themselves is futile, so there is no need for it. The best way for persons concerned about suffering in advanced dementia is to add a supplement to one's advance directive specifying under what circumstances one wants food and fluids assistance stopped.

“…advance care planning, advance directive, autonomy, dementia, end of life, ethics, family, feeding methods, morals COMMENTARY Dr. Terman aims to inspire debate on the issue of facilitating "timely dying" in advanced dementia. 1 He presents arguments for and against the view that advance directives, indicating when ceasing assisted feeding and hydration is allowed, can lead to morally justified interventions that prevent prolonged dying with suffering. We recognize and underline the importance of a constructive dialogue on this morally charged topic.…”

Section: Introductionmentioning

confidence: 99%

Commentary: Can an effective end‐of‐life intervention for advanced dementia be viewed as moral?

Scheeres‐Feitsma,

Schaafsma,

van der Steen

et al. 2024

We comment on Dr. Terman's considerations on the moral justification of ceasing assisted feeding and hydration for people with advanced dementia. The core idea of his paper is that an advance directive can solve future dilemmas regarding assisted feeding. We submit that this static instrument is unfit for the complex and dynamic nature of assessing how to deal with refusals to eat, in particular for people with dementia. It overvalues the past in relation to the present situation and leaves no room for the possibility of changing wishes. Moreover, the perspectives of professional caregivers and families are not addressed because the focus is entirely on individual autonomy in early dementia. Multiple perspectives should be considered in interpreting directives and the actual situation in light of the patient's view of life in order to realistically account for what is morally justifiable in care in advanced dementia.