For many aging adults, quality of life means more than longevity. Losing cognitive functions diminishes quality of life to such an extent that many do not want to drain their family emotionally or drain their finances. To prevent this from occurring a developing new approach for advance directives has been to include terms allowing the person to voluntarily stop eating and drinking (VSED).
The ethics of VSED continues to stimulate debate among physicians, elder law attorneys and those involved in hospice and palliative care. On one side, it is viewed as assisted suicide and on the other side it provides a person with the control to end personal suffering. Some even argue that forcing someone to eat equates with forcing upon them an unwanted medication or medical procedure.
The medical community at this point seems to take the position that VSED should be an option for any mentally competent, terminally ill and suffering patient. This allows patients to make an informed decision that reflects their wishes. In response, hospice provides the necessary support during the process and bereavement care for the family members. Hospice providers must disclose their VSED policies so that patients and family members can make an informed decision about each particular provider to ensure it is consistent with the patient’s wishes about VSED.
So while VSED may be used for mentally competent adults, what happens in the case of those with conditions such as dementia? Can patients specify in advance directives to arrange for VSED under certain conditions? Dementia is a terminal condition but it progresses slowly, often over years. For many death-with-dignity assisted suicide approaches, the law requires a doctor to acknowledge that death is expected to occur within 6 months. Rarely can a physician make that declaration over a dementia case.
The dilemma here is that someone executes an advance directive requiring a VSED approach, then it is not presented to healthcare professionals for many years. The person later progresses into cognitive decline and therefore cannot make a current decision to confirm or deny the terms designated in those advance directives. This makes it difficult for healthcare professionals to execute on removing nourishment from a patient.
At this time, the legal status of VSED by advance directive remains untested. At Stouffer Legal, we continue to keep track of evolving elder law issues such as this. For more information on advance directives and estate planning, contact our elder law attorneys in the Greater Baltimore area. You can schedule an appointment by calling us at (443) 470-3599 or emailing us at office@stoufferlegal.com.
