TY  - JOUR
T1  - Limitations of Advance Directives on Withdrawing Assisted Feeding in Late-Stage Dementia and Their Impact on Timing of Death
A1  - Ayuk Patricia
JF  - Asian Journal of Ethics in Health and Medicine
JO  - Asian J Ethics Health Med
SN  - 3108-5059
Y1  - 2023
VL  - 3
IS  - 1
DO  - 10.51847/NTDZo2ypPf
SP  - 126
EP  - 150
N2  - Advanced Alzheimer’s disease and other late-stage dementias can lead to a prolonged, distressing terminal phase, often lasting years when caregivers continue oral feeding and hydration. Options to prevent extended dying are limited because patients with advanced dementia are ineligible for Medical Aid in Dying. Legal and medical authorities frequently require clear, convincing proof of a patient’s wish to die—something many advance directives fail to provide. Substituted judgment by proxies or agents may also diverge from the patient’s true desires. While advance directives represent a potential last recourse for achieving a dignified and timely death aligned with a patient’s lifelong values, their effectiveness depends on being both enforceable and acceptable. Even a single flaw can justify refusal by opponents to honor requests to discontinue assisted feeding. This article examines 24 common shortcomings in advance directives, organized into four categories. Process flaws concern the manner in which patients articulate their end-of-life preferences. Content flaws involve the choice and description of medical conditions and interventions. Inherent flaws may render directives unacceptable to authorities wary of premature death. The discussion also addresses strategies to ensure physicians issue necessary orders and to prevent third parties from undermining them. Excerpts from dementia-specific directives or supplements—primarily from the US and Europe—illustrate each flaw. None of the directives reviewed contained an effective method for resolving a longstanding ethical conflict: the directive requests “Cease assisted feeding,” yet the incapacitated patient seems to indicate a desire to “Continue assisted feeding.” Some critics use this apparent conflict to justify strict paternalistic intervention. This article proposes a protocol aimed at preventing such conflicts, potentially reducing the need for authorities to impose additional clinical criteria before honoring patients’ directives. By highlighting common flaws, this critique provides guidance for drafting and selecting advance directives that are more likely to be effective and respected in dementia care. It also raises important ethical and clinical questions for those in positions of authority: Does paternalistic refusal to honor a patient’s wishes truly uphold self-determination? Does it protect vulnerable patients from harm, or does it instead prolong suffering? Does it align with bioethical principles and the core tenets of patient-centered care?
UR  - https://smerpub.com/article/limitations-of-advance-directives-on-withdrawing-assisted-feeding-in-late-stage-dementia-and-their-i-ssrraispho2fmgk
ER  -