Choosing an End Game for Dementia

A number of elderly people create an advance directive that states that they do not wish to have life-saving measures performed in the case of a medical emergency. But now, more seniors are adding a new provision to their advance directives that state that if they develop a certain level or form of dementia or Alzheimer’s disease they do not want any type of nutrition or hydration. It has started a quiet debate among medical professionals over whether seniors who develop dementia can use this method to hasten the end of their lives in an advance directive.

Use of an Advance Directive for Dementia

The measure at issue is called “voluntarily stopping eating or drinking,” otherwise known as VSED, and it is a common end-of-life strategy for elders dying of a terminal illness. However, only a handful of people have incorporated the strategy into their advance directive as it pertains to dementia and Alzheimer’s disease.

The number of elderly suffering from dementia has seen a fairly significant increase in recent years with the Baby Boomer generation reaching the age where dementia can affect them and their parents. As of now, over thirty percent of seniors over the age of 85 are affected by Alzheimer’s or another form of dementia. “People in their 50s and 60s frequently say: ‘I don’t want to be in that situation. I don’t want to put my family in that situation and people will increasingly voice those views to others, sometimes in a formal way through advance directives.”

Even in states that allow physicians to prescribe lethal amounts of drugs to someone with a terminal disease, the law requires that the patient be mentally competent and able to ingest the drugs themselves. This means that patients with dementia are unable to die with dignity, even though multiple studies have shown that VSED is a comfortable way to die.

Issues with Dementia and Advance Directives

Although experts agree that dementia is a terminal disease, it presents unique obstacles for seniors who wish to choose how they wish to die. Generally, dementia kills slowly over years, and there is no specific point where there is “the plug” to pull. With dementia, there is no life-sustaining treatment that can be withheld.

The main issue with using VSED for patients with dementia is whether it should be allowed for seniors who later do not remember or understand why they wanted to exit in this way. Even medical professionals in support of the method admit that the patients, their families, and their doctors will face a lot of controversy if they try to cut off food and water to a person with dementia.

Moreover, the issue of using VSED with a patient that is suffering from dementia has been untested in court. The Hastings Center Report recently wrote an article where two advocates of the procedure argued that food and water should not be withdrawn until severe dementia has eroded the patient’s quality of life and “the self has withered.” In addition, several states have strict laws that make it difficult to withdraw food and water, even if it is in an advance directive.

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