Featured Research

from universities, journals, and other organizations

Exploring legal, ethical gray area for people with dementia

Date:
June 5, 2014
Source:
The Hastings Center
Summary:
Many of the legal and ethical options for refusing unwanted interventions are not available to people with dementia because they lack decision-making capacity. But one way for these people to ensure that they do not live for years with severe dementia is to use an advance directive to instruct caregivers to stop giving them food and water by mouth. This is an ethical and legal gray area explored in recent commentaries and a case study.

Many of the legal and ethical options for refusing unwanted interventions are not available to people with dementia because they lack decision-making capacity. But one way for these people to ensure that they do not live for years with severe dementia is to use an advance directive to instruct caregivers to stop giving them food and water by mouth. This is an ethical and legal gray area explored in commentaries and a case study in the Hastings Center Report.

People with decision-making capacity have the legal right to refuse treatment of any kind and to voluntarily stop eating and drinking. In states where physician aid in dying is legal, people with decision-making capacity who are terminally ill can ask a doctor to help them end their lives. For people who lose decision-making capacity, an advance directive can express their wish to refuse life support, including a feeding tube. But it is questionable whether there is a legal right to use an advance directive to refuse food and water given by mouth when a person can still swallow but lacks decision-making capacity.

In the lead article in the May-June issue, Paul T. Menzel and M. Colette Chandler-Cramer express support for such directives and say that they "are arguably already legal" because they follow logically from the legal rights to refuse life support and to voluntarily stop eating and drinking. Menzel, a professor of philosophy emeritus at Pacific Lutheran University, and Chandler-Cramer, a retired physician assistant and a member of a hospital hospice team in Washington State, propose guidelines for implementing such directives so as to guard against misunderstanding and abuse, and they offer a sample advance directive.

A commentary by Rebecca Dresser calls the proposal "both appealing and unsettling." Dresser, who is Daniel Noyes Kirby Professor of Law and professor of ethics in medicine at Washington University in St. Louis, writes that this use of an advance directive "is appealing because it offers some relief to people seeking to avoid the prolonged decline and extreme incapacity they have witnessed in relatives and friends with advanced dementia," but she cautions that it fails to protect incompetent patients.

A case study with commentaries concerns a 75-year-old woman with Alzheimer's disease who, in discussions with her husband, "was adamant about not coming to the point where she would be unable to recognize herself, her husband, or their son and daughter." She made a plan to voluntarily stop eating and drinking on a specific date. "She asked her husband to promise, should she ever waver and request nutrition or hydration, to remind her of the reasons she had chosen for pursuing this path," said the case study. However, after voluntarily stopping eating and drinking, the women asked her caregivers -- friends and hired professionals -- for food and drink. While she sometimes exhibited decision-making capacity, she often did not recall having chosen VSED.

The commentaries explore whether health care workers can follow a family member's request to honor their loved one's VSED plan when the patient's advanced dementia makes disciplined voluntary action difficult. The commentaries are written by Ross Fewing, director of ethics at St. Joseph Medical Center in the PeaceHealth System in the Pacific Northwest; Timothy W. Kirk, an assistant professor of philosophy at City University of New York, York College; and Alan Meisel, the Dickie, McCamey and Chilcote Professor of Bioethics and professor of law at the University of Pittsburgh Schools of Medicine and Law.

The report's abstract can be found online at: http://www.thehastingscenter.org/Publications/HCR/Detail.aspx?id=6876


Story Source:

The above story is based on materials provided by The Hastings Center. Note: Materials may be edited for content and length.


Journal References:

  1. Paul T. Menzel and M. Colette Chandler-Cramer. Advance Directives, Dementia, and Withholding Food and Water by Mouth. Hastings Center Report, 44, no. 3 (2014): 23-37
  2. Rebecca Dresser. Toward a Humane Death with Dementia. Hastings Center Report, 44, no. 3 (2014): 38-40
  3. Ross Fewing, Timothy W. Kirk, Alan Meisel. A Fading Decision. Hastings Center Report, May 2014 DOI: 10.1002/hast.309

Cite This Page:

The Hastings Center. "Exploring legal, ethical gray area for people with dementia." ScienceDaily. ScienceDaily, 5 June 2014. <www.sciencedaily.com/releases/2014/06/140605155730.htm>.
The Hastings Center. (2014, June 5). Exploring legal, ethical gray area for people with dementia. ScienceDaily. Retrieved September 21, 2014 from www.sciencedaily.com/releases/2014/06/140605155730.htm
The Hastings Center. "Exploring legal, ethical gray area for people with dementia." ScienceDaily. www.sciencedaily.com/releases/2014/06/140605155730.htm (accessed September 21, 2014).

Share This



More Science & Society News

Sunday, September 21, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Climate Change Rally Held in India Ahead of UN Summit

Climate Change Rally Held in India Ahead of UN Summit

AFP (Sep. 20, 2014) Some 125 world leaders are expected to commit to action on climate change at a UN summit Tuesday called to inject momentum in struggling efforts to tackle global warming. Duration: 00:41 Video provided by AFP
Powered by NewsLook.com
Sierra Leone's Nationwide Ebola Curfew Underway

Sierra Leone's Nationwide Ebola Curfew Underway

Newsy (Sep. 20, 2014) Sierra Leone is locked down as aid workers and volunteers look for new cases of Ebola. Video provided by Newsy
Powered by NewsLook.com
The Cost of Ebola

The Cost of Ebola

Reuters - Business Video Online (Sep. 18, 2014) As Sierra Leone prepares for a three-day "lockdown" in its latest bid to stem the spread of Ebola, Ciara Lee looks at the financial implications of fighting the largest ever outbreak of the disease. Video provided by Reuters
Powered by NewsLook.com
U.S. Food Makers Surpass Calorie-Cutting Pledge

U.S. Food Makers Surpass Calorie-Cutting Pledge

Newsy (Sep. 18, 2014) Sixteen large food and beverage companies in the United States that committed to cut calories in their products far surpassed their target. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins