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New VSED Advance Directive - Progress, but Problems Persist.

Jordan Potter1, Christopher Masciari1

  • 1Ethics Department, https://ror.org/040cn9093Community Health Network Inc, United States.

The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics
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Summary
This summary is machine-generated.

Advance directives (ADs) for voluntarily stopping eating and drinking (VSED) in dementia patients are complex. Minimal comfort feeding offers a more ethical and practical approach, balancing patient interests and reducing caregiver distress.

Keywords:
VSEDadvance directiveadvanced dementiadementiavoluntarily stopping eating and drinking

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Area of Science:

  • Medical Ethics
  • Geriatric Medicine
  • Palliative Care

Background:

  • Advance directives (ADs) are legal documents outlining patient wishes for end-of-life care.
  • Voluntarily stopping eating and drinking (VSED) presents unique ethical, legal, and practical challenges, especially in advanced dementia.
  • Existing VSED ADs have shortcomings in addressing these complexities.

Purpose of the Study:

  • To critically evaluate the ethical, legal, and practical complexities of VSED ADs in advanced dementia.
  • To assess a newly proposed VSED AD designed to overcome existing limitations.
  • To propose an alternative ethical framework and strategy for end-of-life care in advanced dementia.

Main Methods:

  • Review of existing literature and ethical frameworks concerning VSED and ADs.
  • Analysis of a novel VSED AD proposed by Pope and colleagues.
  • Ethical commentary and argumentation regarding the justification and implementation of VSED ADs.

Main Results:

  • Current VSED ADs have significant ethical and practical limitations.
  • A new VSED AD may not fully resolve the ethical dilemma of honoring VSED wishes amidst patient distress.
  • The ethical justification for honoring VSED ADs when patients exhibit distress and suffering remains insufficient.
  • Moral distress among caregivers may arise from honoring VSED ADs in such circumstances.

Conclusions:

  • Minimal comfort feeding is presented as a more ethically sound and practical alternative to VSED in advanced dementia.
  • This approach better balances the patient's immediate and long-term interests.
  • Addressing ethical complexities and caregiver moral distress is crucial for effective end-of-life care strategies.