DEEP DIVE: ADVANCE DIRECTIVES AND DEMENTIA
This page is created to supplement other pages, primarlily the Advance Directive page, but also the one dealing with Dementia. Those pages have links to here.
ADVANCE DIRECTIVES THAT CALL FOR STOPPING EATING & DRINKING (SED) AFTER INCAPACITY
In the informative book, Voluntarily Stopping Eating and Drinking by Timothy E. Quill, Paul T. Menzel, et al., the authors devote Part II to “Stopping Eating and Drinking by Advance Directive (SED by AD) for Persons Without Decision Making Capacity.” SED by AD raises a legal issue, are food and fluids medical treatments? If they are, then the agent has the authority to carry out SED by AD. If they aren’t, then the agent doesn’t. In other words, does the agent have authority to cause the death of the principal? If s/he doesn’t, then the agent is committing a felony, assisting suicide or murder.
If the agent’s medical decision isn’t expected or designed to cause death, but does so unexpectedly, there is no such crime; the agent is merely carrying out her or his authorized responsibilities. But is it the same if the intent is, based on the SED directive, to cause death? The answer probably depends, according to the VSED book, on whether food and drink are medical treatments. There is no answer from the courts on this issue. As far as this author knows, the issue has yet to be pursued in the courts.
Here is the background. The Supreme Court of the United States has held that people have a right not only to obtain medical treatment, but to deny or terminate medical treatment, even if such denial or termination leads to death. Doctors’ wishes and opinions must stand aside for the individual’s own decision.
The states have determined that when a person is incapacitated, his or her agent, with a durable power of attorney for health care, can make the same decisions the patient/principal could have made had s/he not lost capacity. Thus we have advance directives.
The question of whether food and fluids are medical treatments has become a major issue in the right-to-die movement.
Largely because of this issue the final choices in this website’s directive, giving the agent authority to institute SED by AD, creates the opportunity for this to be litigated. Of course litigation is not the best way to go.
Legislation would be better. This has been done in Nevada.
THE BURDEN OF CHOOSING STOPPING EATING & DRINKING (SED) IN THE ADVANCE DIRECTIVE FORMI
Principals who direct SED by AD are asking their agent to intentionally oversee their death. That is placing a very heavy burden on the agent and others involved. The agent must be willing to accept this burden. Again, a conversation essential.
In this website’s AD form page 2, the four choices under #5 create this burden, unless the prior sentence, #5, is chosen too.
Choosing the four without also choosing the preceeding sentence, #5, could well mean that the agent must go to court to assert the principal’s right to end her or his life this way – an expensive and very time consuming process. Be very careful about putting your agent and family in this situation. In Nevada, this shouldn’t be a problem.
OTHER DEMENTIAS
Here are three prevalent dementias:
Vascular – hardening of the arteries in the brain., Huntington’s – a break down in the brain’s nerve cells. Lewy Body – abnormal deposits of the brain protein alpha-synuclein. In Alzheimer’s, lewy body and tau proteins become twisted. In this link you will find the details of the dementias listed above and the names and details of many other dementias.
Furthermore, dementia can arise secondarily in the late stages of other diseases, namely Parkinson’s, HIV, multiple sclerosis and alcoholism.
OTHER ADVANCE DIRECTIVE FORMS
The main sources of free forms are each state’s statutory forms, which can be found here. Another free form is the Veterans’ Administration version.
Two for-fee forms, the first of which is very popular (with a slight religious bias), are: Five Wishes, and Formswift’s Living Will/Advance Directive.
PREVENTING ALZHEIMER’S DISEASE
Some research progress is being made on reversing Alzheimer’s in its very early stage.
Extensive recent medical research clearly indicates that with a healthy lifestyle one has a good chance of preventing Alzheimer's disease.
What life style changes? (As many as you can do; the more, the better.)- Eat healthy
- Exercise regularly
- Avoid negative thinking
- Do what you enjoy
- Have a good sense of humor
- Meditate, live mindfully
- Socialize
- Get outside into nature
- Actively relax – listen to music, garden, etc.
- Get a massage – even the 15 minute ones
- Change your environment – take a trip
- Stop multitasking
- Turn off electronic devices
- Take supplements, especially B complex, C, zinc, magnesium
This list is taken from a class on prevention given at the San Diego Community Colleges in the fall of 2022. You can get similar information from this YouTube video: Ten tips to prevent Alzheimer’s, Melissa Batchelor. There are others.