The misleading simplicity of advance directives

Abstract

The question of what constitutes a dignified old age has always been a topic of philosophical enquiry. Already in the writings of the stoic philosophers we can find relevant contributions to an ethic of “successful” aging. Seneca, for instance, reflects upon the pleasures of old age in several of his famous “Letters to Lucilius” (Seneca, 1967). However, he also writes about the bad years that may lie ahead and confides to his pupil: “Do not hear me with reluctance as if my statement applied directly to you, but weigh what I have to say. It is this. I shall not abandon old age, if old age preserves me intact for myself, and intact as regards to the better part of myself; but if old age begins to shatter my mind, and pull its various faculties to pieces, if it leaves me, not life, but only the breath of life, I shall rush out of a house that is crumbling and tottering . . .”

Facilitating independence: The benefits of a post-diagnostic support project for people with dementia

“…This reflects Sampson et al (2010) who identified that carers' difficulties with making advance care plans for family members with severe dementia included conflicting family dynamics, a general unwillingness to address end of life issues, difficulty with making decisions about hypothetical scenarios and difficulty accepting future deterioration. Hertogh (2011) identified difficulties with advance care plans made by people with dementia themselves as including concerns over the stability of decisions over time, the desire of people not to make decisions about their future or to share decision making with others, and a conflict between professional duty of care and the person's decision. These, and our findings, highlight the importance of recognising that decisions on difficult topics, particularly advance care planning, will take time and of allowing people to arrive at their own position in their own time, with the support of a familiar and trusted support worker.…”

Decision-making capacity and communication about care of older people during their last three months of life

“…Over half of the relatives considered the AD of additional value, while at the same time only a small group considered that the AD determined decisions. This might indicate that relatives also see the role of an AD more as an aid in communication on end-of-life care and treatment, as some authors have suggested [21,22]. However, it would be desirable for future research to get more in-depth insight in the ways in which relatives experience the additional value of ADs.…”

Thoughts on the Future: The Perspectives of Elderly People with Early-Stage Alzheimer's Disease and the Implications for Advance Care Planning

“…The designation of a durable power of attorney may also be a possible outcome of ACP. Anticipating the future and advance care planning involves a broader concept than the mere signing of a form or marking a checklist of interventions to be accepted or denied (Hertogh 2011). Further development and testing of models for ACP in dementia care, in which realistic goals of care are central, is essential in order to adequately adjust the care to the needs and the wishes of the people involved.…”