Critique
of
THE
DEMENTIA PROVISION
suggested
by Compassion & Choices
The following is the text of the suggested Dementia
Provision:
~~~~~~~~~~~~~~~~~
"If I have a progressive illness affecting my thought processes,
and the illness is in an advanced stage,
and I am consistently and permanently unable to communicate,
swallow food and water safely,
care for myself
and recognize my family and other people,
and it is very unlikely that my condition will substantially improve,
I would like my wishes regarding specific life-sustaining treatments,
as indicated on the attached Advance Directive
for permanent unconsciousness to be followed.
If I am unable to eat and drink for myself while in this condition:
I do / do not (circle one) want to be fed and given
liquids by mouth.
I hereby incorporate this provision into my durable power of attorney
for health care,
living will and any other previously executed advance directive for
health care decisions.
___________________________
______________________
Signature
Date"
~~~~~~~~~~~~~~~~~~~~~~
PROBLEMS WITH THE ABOVE FORMULATION:
EACH OF THE SEVEN CONDITIONS DESCRIBED MUST BE MET
The suggested formulation lists seven specific
conditions.
Each is connected to the others on the list by the word "and".
Legally this means that if just one of the conditions is not met,
then the whole provision does not come into effect.
For example, if I am still able to "swallow food and
water safely",
then I am not demented enough for this document to be applied.
Many demented patients can still be fed by spoon
and can still drink water without choking.
Should we wait until a feeding-tube is required
before this provision becomes effective?
SOME OF THE CONDITIONS ARE DESCRIBED TOO VAGUELY
The general idea expressed in each of the seven
test-conditions
is clear enough for most purposes.
But when lawyers become involved in the evaluation of conditions,
they will be able to raise doubts about most of the conditions
described.
For example: "recognize my family and other people".
When Terri Schiavo was in the persistent vegetative state,
many family members and their lawyers claimed
that Terri was still responding to them.
Another example: "care for myself".
Just how debilitated must I be to be
"consistently and permanently unable to...care for myself"?
If I am still able to dress myself (perhaps with assistance),
if I can still swallow my food and water safely,
do such behaviors show that I can still "care for myself"?
Lawyers could line up on either side of this question.
And even proxies might be unable to decide
whether this condition has been met.
And, as said in the first problem noted above,
if one condition of
the seven is not fulfilled,
then the whole document is null and void.
AN
ALTERNATIVE COMPREHENSIVE ANSWER
The comprehensive Advance Directive for Medical Care
of James Leonard Park addresses these questions of mental deterioration
in 5 pages of discussion:
https://s3.amazonaws.com/aws-website-jamesleonardpark---freelibrary-3puxk/PVS-JP.html
This Answer was generated in response to the
following Question:
Question
6: How do you want
to be treated if you get Alzheimer's disease
or some other condition that limits your mental abilities?
Other Advance Directives will probably answer this
Question in less than 5 pages.
But some families might benefit from this detailed discussion.
Readers are invited to adapt these ideas as appropriate
for their own Advance Directives for Medical Care.
Created
February 8, 2009; Revised 2-9-2009; 2-13-2009; 1-26-2019;
See
related bibliographies:
Best
Books on Voluntary Death
Best
Books on Preparing for Death
Books
on Terminal Care
Books
on
Hospice Care
Books on Helping People to Die
Books
Supporting the
Right-to-Die
Books
Opposing
the Right-to-Die
Return to the DEATH
page.
Go to the Medical
Ethics
index page.
Go to
the beginning of this website
James
Leonard Park—Free
Library