Decision-Making: At the End of Life and the Provision of Pretreatment Advice

Pope, Thaddeus Mason; Richards, Bernadette

doi:10.1007/s11673-015-9652-6

Cited by 6 publications

(1 citation statement)

References 3 publications

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“…Although this patient's desire can be interpreted as an abbreviation of life or acceleration of death, it must be understood that this choice may be related to the individual's objective of not getting nausea, abdominal distension, motion sickness, among other discomforts. At this point, a medical and psychological evaluation can help to identify more precisely the objective of these patients: whether they really want to have an outcome for death more quickly or not (13)(14) .…”

Section: Contribuições Da Fonoaudiologia Nos Cuidados Paliativos E No Fim Da Vidamentioning

confidence: 99%

Contribuições da Fonoaudiologia nos cuidados paliativos e no fim da vida

Moreira

Guimarães

Lopes

et al. 2020

CoDAS

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Section: Contribuições Da Fonoaudiologia Nos Cuidados Paliativos E No Fim Da Vidamentioning

confidence: 99%

Contribuições da Fonoaudiologia nos cuidados paliativos e no fim da vida

Moreira

Guimarães

Lopes

et al. 2020

CoDAS

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Whether, When, and How to Honor Advance VSED Requests for End-Stage Dementia Patients

Pope¹

2019

The American Journal of Bioethics

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Flaws in advance directives that request withdrawing assisted feeding in late-stage dementia may cause premature or prolonged dying

2022

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Background The terminal illness of late-stage (advanced) Alzheimer’s and related dementias is progressively cruel, burdensome, and can last years if caregivers assist oral feeding and hydrating. Options to avoid prolonged dying are limited since advanced dementia patients cannot qualify for Medical Aid in Dying. Physicians and judges can insist on clear and convincing evidence that the patient wants to die—which many advance directives cannot provide. Proxies/agents’ substituted judgment may not be concordant with patients’ requests. While advance directives can be patients’ last resort to attain a peaceful and timely dying consistent with their lifelong values, success depends on their being effective and acceptable. A single flaw can provide opponents justification to refuse the directive’s requests to cease assisted feeding. Aim This article considers 24 common advance directive flaws in four categories. Process flaws focus on how patients express their end-of-life wishes. Content flaws reflect drafters’ selection of conditions and interventions, and how they are described. Inherent flaws can make advance directives unacceptable to authorities concerned about premature dying. Strategies are needed to compel physicians to write needed orders and to prevent third parties from sabotaging these orders after they are implemented. The article includes excerpts from “dementia-specific” directives or supplements that exemplify each flaw—mostly from the US and Europe. No directive critiqued here included an effective strategy to resolve this long-debated bioethical conflict: the past directive requests “Cease assisted feeding” but the incapacitated patient apparently expresses the desire to “Continue assisted feeding.” Some opponents to the controversial request, cease assisted feeding, use this conflict as a conceptual wedge to practice hard paternalism. This article proposes a protocol to prevent this conflict from emerging. These strategies may prevent authorities from requiring patients to fulfill authorities’ additional clinical criteria as a prerequisite to honor the requests in patients directives. Conclusion This critique of flaws may serve as a guide to drafting and to selecting effective and acceptable advance directives for dementia. It also poses several bioethical and clinical questions to those in authority: Does your paternalistic refusal to honor patients’ wishes respect their self-determination? Protect vulnerable patients from harm? Force patients to endure prolonged suffering? Violate the principles of bioethics? Violate the very foundation of patient-centered care?

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Decision-Making: At the End of Life and the Provision of Pretreatment Advice

Cited by 6 publications

References 3 publications

Contribuições da Fonoaudiologia nos cuidados paliativos e no fim da vida

Contribuições da Fonoaudiologia nos cuidados paliativos e no fim da vida

Whether, When, and How to Honor Advance VSED Requests for End-Stage Dementia Patients

Flaws in advance directives that request withdrawing assisted feeding in late-stage dementia may cause premature or prolonged dying

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